Hello Malcolm, great to see you here again and I`m very pleased you`re chiming in on this topic, this is all very interesting stuff.  Reading your posts makes me remember how much we miss you!

Sounds like you`re still keeping very busy, and that doesn`t surprise me at all.  I had to smile about your doc`s comments that you have "unrealistic expectations", don`t we all!! 

Cheers! 

Very interesting information all around. Glad to see you peeking in here more often Mallani ... you have been missed.

Hey I missed your last post somehow mallani - so, my post crossed yours in the mail I guess. VERY interesting your news!

My prior pre-treatment fibroscan was 12.6 kPa's, my recent EOT+24 week fibroscan was 11.8 kPa's. I'll take it, calmly, with a grain of salt, and all of the many variables included!

She was motivated to perform the task twice this time!, she looked perplexed and somewhat un-pleased (much to my silent curiosity), so, she did it all over again! ... don't know why ... highest ranges were between 7/8 up to 14+, so, law of averages (plus her doing it twice!), I would guess it's "semi-indicative" of a lukewarm "semi-firm" (pun) perhaps telling downward direction!!!! I will look forward to the further additional info my future labs/US's and fibroscan's try to tell me.

Please do keep us posted, on your work and you.  C.

I'm not surprised that you went back to work! You were meant to stay involved and I'm glad you're continuing. Sounds like you enjoy where you're at. Do you work with the students much? That would probably be a bit hectic, but rewarding. Students can be an interesting bunch!

The opinions on fibrosis regression have really been varied. I'm not surprised that regression takes time. Just makes sense that scar tissue would take awhile to reabsorb, if it does completely. Any word on new anti fibrotic drug therapies? There seems to be an ocean full of data everywhere you look. We all appreciate your knowledge and it's accuracy. 

Good to hear from you!

Mallani,

Well that sounds all pretty good! 

- Controlled A1C's for your efforts.

- Knowing, the new, better U/S's have the ability to scare the bejeezuz out of one, with clear pics of things that turn out to be only unbefore seen benign stuff! Nice tho that imaging can show you where old nodules have resolved! "Old/resolved" sounds very good! Can't rightly recall now what kind of imaging wlmj got to show his thought hemanginoma's.

If I can manage to remember any of your probe details, I will try to ask, at my upcoming U/S what they do/use.

I would be interesting to know your work with fibroscans, and would look forward to hearing more on it.

Yes, I try to keep things open, consider everything, being that I know nothing, it's a safe policy for me. I like to hear people say what they think is rubbish, like ... wasn't it your doc who said rubbish to your metformin, and had the metformin half tossed in the bin! hee hee. Hard to tell, isn't it sometimes - maybe it IS mostly your good dietary control measures that are keeping things best controlled! Regardless, you deserve some personal credit here for your dietary efforts!, as the jury still seems to be out on metformin? Just guessing, but by 50/50 likely association, neuropathy does kinda "go with" diabetes territory, and diabetes can kinda go with HCV territory, so ...? 

The Lim article was edited/shortened, and it did not include the links to the study and refs.

Ya, what Tig said ... what's your latest F score deducing??

Good to see you around here!  C.

Hi Tig,

Glad to see the Forum remains in good hands! Man, the topics have changed over the years.

I've just come out of retirement briefly, to do some Fibroscan sessions for my Hepatologist (as I mentioned, he's also Dean of our Medical School).

Naturally, I did 3 examinations on myself. I've wondered about the effect of fasting, so I did one fasting (8 hours), one 2 hours post food, and one 4 hours post food. The readings were: 9.8, 10.1 and 9.9 kPa.

I guess that confirms that fasting doesn't have any significant effect on readings. All our patients were told to fast for 2 hours prior to the exam. It has been thought that higher readings were obtained immediately after food.

I'm a bit disappointed as I has hoped for a lower reading, now that my glucose is under control and presumably, had less fat in the hepatocytes. When I told my Doc, he laughed and told me I had unrealistic expectations.

I did scan 4 post SVR cirrhotics: the time period after SVR ranged from 12 months to 30 months. In all 4 cases, the readings had not changed significantly. The patients weren't happy! The feeling around here is that fibrosis resolution takes many years.

There was one interesting patient. She was mid-forties and had a TE study using an add-on program to a standard GE Ultrasound machine. Her reading was 17, making her cirrhotic. My doc didn't accept that as her ALT was normal. When I scanned her, the reading was 11.6kPa (F2-3). It's a point worth making- if you get a Fibroscan, it should be done on a dedicated machine, not on a money-making add-on.

Anyway, back to golf and fishing. We just had our 50 year reunion for the Medical Class of 1966. Many guys are still working!

Cheers all- sorry to go off-topic.

Hello Malcolm,

Great to see you again! I always enjoy the information discussed when you check in. When you and Canuck get started on some of these topics, it requires intense attention to detail. It's interesting to follow your discussions, thanks as always.

Wishing some of you were close, we could help you with those ultrasounds! I asked my wife about doing Fibroscans some time ago and that would require the Echosens equipment and probes. We don't have that capability with our current equipment. 

Mal, what's the latest on your fibrosis score? Any further regression? Hope things are coming along for you, Lani and Rusty! Cheers 

Hi again Canuck,

I'm getting older, but can't complain.

I've been on Metformin (500mg/day) for 3 months and my HbA1C has dropped to normal (6.4). The low GI diet continues, and my aim is to get to about 6. I'm not increasing the Metformin, and hope to stop it in a year or so.

The Peripheral Neuropathy has not changed. As I do not have any cryoglobulins, I find it hard to accept it's due to HepC. I'm also unsure it's related to diabetes. Perhaps it's cause will remain unknown- like in 50% of cases.

I've repeated my Ultrasound, and my Segment 8 'lesions' have not changed. All the Radiologists, myself included, think the 'lesions' are nothing to worry about. The quality of the US image using the new 9 mHz linear array probes, shows so much detail. The 'lesions' are thought to be old, resolved nodules.

I've been helping out my Hepatologist, doing some Fibroscan sessions for him I'll do a post about that.

Regarding CAP, I've read the stuff- my guy thinks it rubbish and his machine does not give a CAP measurement. It sounds good but I've no experience and nobody in Brisbane does them.

Enjoy SVR! Cheers.

Hey Hi Mallani! 

Nice to see you here! How are ya!

Yup, I wouldn't know what you or Dr. Lim know. I find many of the articles that come up just plain interesting.

Was also interested to read somewhere that ultrasound is limited, in some ways, i.e. like in being able to pick up lower levels of steatosis for instance. Do you think fibroscan CAP is a good adjunct, along with other means of deducing fat levels?

I do know, that I was refused an MRI when I asked if I should have one, the decision "no" was based on justification/the "cost".

I am just pleased that I finally, just recently, managed to convince them to agree to an ultrasound for me (post-treatment)!

So, I will soon have some "forms of feedback" to follow, by being able to compare pre-treatment fibroscan and abd. U/S. to post-treatment repeats. Yay!

Was also interested to read somewhere that ultrasound is limited in picking up low level steatosis, 

How goes the diet, metformin, AC1's, neuropathy, hemanginoma's, etc. ???  C.

Hi Canuck,

With respect, I disagree with Dr Lim.

His article gives very little information. It is vital to know how the HCC Ultrasounds were performed, and what probes and technique were used.

Using the latest US machines, and the variable frequency linear probes, a competent sonographer should be able to detect a lesion of 5 to 7mm in diameter, in 'normal sized' patients. It is vital to use frequencies of 7-9mHz for adequate definition. This is about the same size that MRI can detect. I accept that MRI can better define the vascular features of such a lesion, and it should be performed in any suspicious lesion found by Ultrasound.

It should be realised that MRI (with a liver-specific contrast, such as Primovist), costs $500 to $1,000 and takes up to an hour to perform.

An Ultrasound costs ~$200, and should take 30 minutes at most.

Insurance and Governments would not pay for regular MRI followups. It is hard enough to get them to pay for Ultrasounds.

ALL cirrhotics should have 6 monthly imaging post-SVR, and IMHO, Ultrasound is good enough. Cheers.

MRI bests ultrasound for early detection of HCC - September 28, 2016

Lim SY, et al. JAMA Oncol. 2016:doi:10.1001/jamaoncol.2016.3147.

Magnetic resonance imaging - as opposed to ultrasound - offers a significantly greater chance of detecting hepatocellular carcinoma early, according to a prospective surveillance study published in JAMA Oncology.

"MRI with liver-specific contrast agent markedly outperformed ultrasonography, which is considered a current standard tool according to practice guidelines," Young-Suk Lim, MD, PhD, of the Liver Center at the Asan Medical Center in Korea, told Healio.com/Hepatology. "MRI screening for a high-risk population of hepatocellular carcinomas can help doctors to detect HCCs at very early stage and consequently can open a wide chance of cure and favorable survival for patients."

Lim and colleagues analyzed 1,100 ultrasound and MRI screenings from 407 participants at high risk for HCC. The tests took place, at most, within 2 weeks of the other, three times over 18 months. Of these, 43 were diagnosed with HCC. MRIs detected HCC 86% of the time vs. 27.9% of the time via ultrasound (P < .001).

 ...When a lesion was discovered using either method, the patient underwent a CT scan within 3 months. Cases that were suspicious on CT imaging had biopsies performed with an ultrasound as much as possible; those lesions only detected by MRI underwent a targeted second-look ultrasound to steer the biopsy results, researchers wrote.

The researchers also found false-positive cases in ultrasound outnumbered MRI (5.6% vs. 3%).

"The results of our prospective study support our hypothesis that MRI with liver-specific contrast is more sensitive than [ultrasound] to detect early stage HCC in high-risk patients with cirrhosis." - by Janel Miller ...

Disclosures: Lim reports serving as an advisory board member for Bayer Healthcare, Bristol-Myers Squibb and Gilead Sciences; and receives research funding from Bayer Healthcare, Bristol-Myers Squibb, Gilead Sciences and Novartis. No other financial disclosures were reported.