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FibroScan: Non-Invasive Liver Stiffness Measurement

FibroScan is a non-invasive ultrasound-based procedure used to measure liver stiffness and detect liver fibrosis or cirrhosis, often replacing the need for a liver biopsy.

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Things worth knowing about "FibroScan"

FibroScan is a non-invasive ultrasound-based procedure used to measure liver stiffness and detect liver fibrosis or cirrhosis, often replacing the need for a liver biopsy.

What is a FibroScan?

A FibroScan (also known as transient elastography) is a modern, non-invasive diagnostic procedure used to assess the condition of the liver. Using ultrasound waves combined with low-frequency elastic waves, the device measures the stiffness of liver tissue, providing information about the extent of possible fibrosis (excess connective tissue formation) or cirrhosis (advanced liver scarring). The procedure is painless, takes only a few minutes, and is very well tolerated by patients.

How Does It Work?

During a FibroScan, a special probe is placed on the skin over the right side of the rib cage, directly above the liver. The probe emits a mild mechanical vibration along with an ultrasound pulse. The speed at which the resulting wave travels through the liver tissue is then measured. The stiffer the tissue, the faster the wave travels. Results are reported in kilopascals (kPa). In addition, the FibroScan can also use the CAP parameter (Controlled Attenuation Parameter) to assess the fat content of the liver (hepatic steatosis).

When is FibroScan Used?

FibroScan is used in the following situations:

Suspected or confirmed liver fibrosis or liver cirrhosis
Chronic hepatitis B or C
Non-alcoholic fatty liver disease (NAFLD/NASH)
Alcoholic liver disease
Monitoring of known liver conditions over time
Evaluating treatment response
Assessment before and after liver transplantation

Interpreting the Results

FibroScan results are interpreted using standardized reference ranges. Classification is often based on the METAVIR score (F0 to F4):

F0–F1: No or minimal fibrosis (typically < 7.0 kPa)
F2: Significant fibrosis (approx. 7.0–9.5 kPa)
F3: Advanced fibrosis (approx. 9.5–12.5 kPa)
F4: Liver cirrhosis (> 12.5 kPa)

The exact thresholds may vary depending on the underlying condition and the device used. Results must always be interpreted in the context of the overall clinical picture.

Advantages Over Liver Biopsy

Traditionally, a liver biopsy -- involving the removal of a small tissue sample -- was the standard method for assessing liver structure. FibroScan offers several advantages over this approach:

Non-invasive: no needles, no incision
No risk of bleeding or infection
Painless and suitable for outpatient settings
Rapid results within minutes
Reproducible for follow-up monitoring
Evaluates a much larger tissue volume (approximately 100 times more than a biopsy sample)

Limitations and Potential Sources of Error

Despite its many advantages, FibroScan does have some limitations:

Severe obesity can affect measurement accuracy, although special XL probes are available for obese patients.
Ascites (fluid accumulation in the abdomen) can interfere with the measurement.
Acute liver inflammation can temporarily increase stiffness values, leading to falsely elevated fibrosis scores.
The examination should be performed on an empty stomach or at least 2 hours after eating.
Irregular heartbeat or narrow intercostal spaces may make the measurement more difficult.

How the Examination is Performed

The patient lies on their back with the right arm raised above their head. The clinician or medical professional applies a small amount of ultrasound gel and places the probe on the skin over the liver. A standard examination involves 10 valid measurements, from which a median value is calculated. The entire procedure takes approximately 5–10 minutes and is completely painless.

References

European Association for the Study of the Liver (EASL): EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 2021.
Castera L, Friedrich-Rust M, Loomba R: Noninvasive Assessment of Liver Disease in Patients with Nonalcoholic Fatty Liver Disease. Gastroenterology, 2019.
Echosens (Manufacturer): FibroScan Technical and Clinical Documentation. Paris, 2022.

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