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Elastography

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What is an elastography?

Elastography, also known as liver elastography, is a type of imaging test that checks the liver for fibrosis. Fibrosis is a condition that reduces blood flow to and inside the liver. This causes the buildup of scar tissue. Left untreated, fibrosis can lead to serious problems in the liver. These include cirrhosis, liver cancer, and liver failure. But early diagnosis and treatment can reduce or even reverse the effects of fibrosis.

There are two types of liver elastography tests:

  • Ultrasound elastography, also known as Fibroscan, the brand name of the ultrasound device. The test uses sound waves to measure the stiffness of liver tissue. Stiffness is a sign of fibrosis.
  • MRE (magnetic resonance elastography), a test that combines ultrasound technology with magnetic resonance imaging (MRI). MRI is a procedure that uses powerful magnets and radio waves to create images of organs and structures inside the body. In an MRE test, a computer program creates a visual map that shows liver stiffness.

Elastography testing may be used in place of a liver biopsy, a more invasive test that involves removing a piece of liver tissue for testing.

Other names: liver elastography, transient elastography, Fibroscan, MR elastography

What is it used for?

Elastography is used to diagnose fatty liver disease (FLD) and fibrosis. FLD is a condition in which normal liver tissue is replaced by fat. This fat can lead to cell death and fibrosis.

Why do I need an elastography?

Many people with fibrosis don’t have symptoms. But left untreated, fibrosis will continue to scar the liver and eventually turn into cirrhosis.

Cirrhosis is a term used to describe excessive scarring of the liver. Cirrhosis is most often caused by alcohol abuse or hepatitis. In severe cases, cirrhosis can be life-threatening. Cirrhosis does cause symptoms. So you may need this test if you have symptoms of cirrhosis or another liver disease.

Symptoms of cirrhosis and other liver diseases are similar and may include:

  • Yellowing of the skin. This is known as jaundice.
  • Fatigue
  • Itching
  • Bruising easily
  • Heavy nosebleeds
  • Swelling in the legs
  • Weight loss
  • Confusion

What happens during an elastography?

During an ultrasound (Fibroscan) elastography:

  • You will lie on an examination table on your back, with your right abdominal area exposed.
  • A radiology technician will spread the gel on your skin over the area.
  • He or she will place a wand-like device, called a transducer, on the area of skin that covers your liver.
  • The probe will deliver a series of sound waves. The waves will travel to your liver and bounce back. The waves are so high pitched you can’t hear them.
  • You may feel a gentle flick as this is done, but it should not hurt.
  • The sound waves are recorded, measured, and displayed on a monitor.
  • The measurement shows the level of stiffness in the liver.
  • The procedure only takes about five minutes, but your entire appointment may take a half-hour or so.
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MRE (magnetic resonance elastography) is done with the same type of machine and many of the same steps as a traditional MRI (magnetic resonance imaging) test. During an MRE procedure:

  • You will lie on a narrow examination table.
  • A radiology technician will place a small pad on your abdomen. The pad will emit vibrations that pass through your liver.
  • The table will slide into an MRI scanner, which is a tunnel-shaped machine that contains the magnet. You may be given earplugs or headphones before the test to help block the noise of the scanner, which is very loud.
  • Once inside the scanner, the pad will activate and send measurements of vibrations from your liver. The measurements will be recorded onto a computer and turned into a visual map that shows the stiffness of your liver.
  • The test takes about 30 to 60 minutes.

Will I need to do anything to prepare for the test?

You don’t need any special preparations for ultrasound elastography. If you are having an MRE, be sure to remove all metal jewellery and accessories before the test.

Are there any risks to the test?

There are no known risks to having ultrasound elastography. There is little risk of having an MRE for most people. Some people feel nervous or claustrophobic inside the scanner. If you feel this way, you may be given medicine before the test to help you relax.

What do the results mean?

Both types of elastography measure the stiffness of the liver. The stiffer the liver, the more fibrosis you have. Your results may range from no scarring to mild, moderate, or advanced liver scarring. Advanced scarring is known as cirrhosis. Your health care provider may order additional testing, including liver function blood tests or a liver biopsy, to confirm a diagnosis.

If you are diagnosed with mild to moderate fibrosis, you may be able to take steps to stop further scarring and sometimes even improve your condition. These steps include:

  • Not drinking alcohol
  • Not taking illegal drugs
  • Eating a healthy diet
  • Increasing exercise
  • Taking medicine. There are medicines that are effective in treating some types of hepatitis.
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If you wait too long for treatment, more and more scar tissue will build up in your liver. This can lead to cirrhosis. Sometimes, the only treatment for advanced cirrhosis is a liver transplant.

If you have questions about your results, talk to your health care provider.

Is there anything else I need to know about an elastography?

MRE testing may not be a good choice for people who have metal devices implanted in their bodies. These include pacemakers, artificial heart valves, and infusion pumps. The magnet in the MRI can affect the operation of these devices, and in some cases, it could be dangerous. Dental braces and certain types of tattoos that contain metal may also cause problems during the procedure.

The test is also not recommended for women who are pregnant or think they might be pregnant. It is not known whether magnetic fields are harmful to unborn babies.

References

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