FibroScan for Grade 2 Fatty Liver Disease

Rationale for FibroScan in Grade 2 Fatty Liver

Grade 2 fatty liver disease represents moderate steatosis, which puts patients at increased risk for developing fibrosis that can progress to advanced liver disease 1
FibroScan (transient elastography) provides a non-invasive assessment of liver stiffness, which correlates with the degree of fibrosis present 2
The Youden cutoff value of 8.2 kPa (rounded to 8.0 kPa for clinical use) on FibroScan helps identify clinically significant fibrosis (≥F2), which includes grade 2 fatty liver with fibrosis 1, 2

Begin with simple fibrosis scores such as FIB-4 to initially stratify patients 3
FIB-4 <1.3 (<2.0 in those >65 years) reliably excludes advanced fibrosis with ≥90% negative predictive value 1
FIB-4 >2.67 indicates high risk for advanced fibrosis (60-80% positive predictive value) 1
Patients with intermediate FIB-4 scores (1.3-2.67) should proceed to FibroScan 1, 4

Non-invasive alternative to liver biopsy, which has sampling variability issues (25-60% discordance between biopsies from same patient) 6
Allows for monitoring of disease progression or regression over time 6
Can be performed rapidly (5 minutes) in outpatient settings with immediate results 7
Sequential testing using FIB-4 followed by FibroScan for patients with indeterminate scores is more accurate than using either test alone 1, 4

Only procedures with ≥10 successful measurements are considered reliable 7
Success rate should be at least 60% and interquartile range less than 30% of median value 7
FibroScan has limitations in patients with ascites 8, severe obesity 7, narrow intercostal spaces 7, acute hepatitis 7, or extrahepatic biliary tract obstruction 7

Grade 2 fatty liver with significant fibrosis (≥F2) is associated with increased risk of liver-related morbidity and mortality 8
Early identification of fibrosis allows for more aggressive management to prevent disease progression 1, 2
FibroScan results can guide referral decisions to hepatology specialists 2, 5
Patients with LSM <8.0 kPa can be monitored with repeat surveillance testing in 2-3 years 2
Patients with LSM >12.0 kPa should be referred to hepatology for consideration of liver biopsy or additional testing 2