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Post Info TOPIC: Post SVR imaging
Tig


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Hi Sarah,

Here's a link to an explanation on fibrosis staging and the Metavir Score. 

http://hepatitis.about.com/od/diagnosis/a/Metavir.htm

Tig



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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smccune


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Thank you all so much for the info.  I will ask again for a copy.....demand a copy.biggrin



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55 yo female.  Diagnosed 9/2011 Geno 3A.  Treatment delayed because of 9 Month antibiotic tx because of TB Positive test. Began tx 9/20/2013 Interf/Riba 24 wks.  Week 4, 8 undet. 1 year.......UNDETECTED!
Isiscat2011


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Hi smccune:  Just get a copy of your biopsy report.  It should tell you what fibrosis stage you are at as well as other pertinent information.  It is important that we know this information ourselves.

Fibrosis just means scarring.  The HepC virus causes damaged liver tissue to form scars and become stiff.  The level of fibrosis ranges from F0-F4 (based on the scoring system most commonly used in the US).  F-4 means cirrhosis.  Best regards. 

 



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
smccune


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Hi Mallani, the only information my doctor gave me in regards to my biopsy was:"there are changes consistent with inflammation and fatty liver.  There is no evidence of cirrhosis".

I guess I don't really understand what a fibrosis stage is.

I asked numerous times for results and she always just says "you don't have cirrhosis".

Should specifically ask for my fibrosis stage?



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55 yo female.  Diagnosed 9/2011 Geno 3A.  Treatment delayed because of 9 Month antibiotic tx because of TB Positive test. Began tx 9/20/2013 Interf/Riba 24 wks.  Week 4, 8 undet. 1 year.......UNDETECTED!
mallani


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Hi Sarah,

I think you had a biopsy a couple of years back. Do you remember your Fibrosis stage?

The 6 monthly imaging for HCC is for cirrhotics, but the F3's and F3-4's also have a slightly increased risk. Fatty liver also increases the risk of HCC, so it wouldn't hurt to ask for a scan. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
smccune


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Question:  I am almost 5 months post tx and the only thing I have had is a liver biopsy.  That showed fatty liver, but no cirrhosis.   my doctor is an idiot, so I am wondering if I should have an ultrasound etc.  thank you in advance for your input.



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55 yo female.  Diagnosed 9/2011 Geno 3A.  Treatment delayed because of 9 Month antibiotic tx because of TB Positive test. Began tx 9/20/2013 Interf/Riba 24 wks.  Week 4, 8 undet. 1 year.......UNDETECTED!
Gator Man


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mallani wrote:

Hi Gator Man,

Sounds like you've got a great Hepatologist.

 

 Agreed Malcolm. I have been fortunate.



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Geno 1b, compensated cirrhotic, 54 yo, prior null responder. Pre tx VL approx 595,000, tx with Sovaldi/Olysio (no Riba) started 1/8/14. VL 40 @ 2 weeks, UND @ 4 weeks. Still UND @ EOT + 1 year.

Gator Man SVR12, Dragon 0, Final Score.
mallani


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Hi Gator Man,

Sounds like you've got a great Hepatologist.

Between 1995 and 2005, I used to Ultrasound myself. When I saw something a bit odd in 2005, I had an MRI. This confirmed a 12mm round lesion in segment 2 of the L liver lobe. This is close to the stomach, and is an area that is difficult to see. The MRI was done with IV contrast, and despite delayed sequences, it was not a typical haemangioma. The MRI was repeated 3 months later, and the lesion had not changed, and after showing it to several Radiologists, we concluded it must be an atypical haemangioma. I then stopped doing my own Ultrasounds, and had a CT or MRI each year. The 'lesion' has not changed since then, and was very obvious on yesterday's ultrasound. In short, you don't need an MRI if the Radiologist is happy with the quality of the ultrasound.

OldenSlow: There's nothing wrong with getting another Fibroscan, and you can get a followup whenever you like. My doc told me that some of his SVR patients don't show much change, so don't be disappointed. For me, I want to forget it for a while. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
OldenSlow


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Gator Man wrote:

 

Do I insist on MRIs and/or FibroScans just to satisfy my curiosity? I think there is something to be said for knowing if fibrosis has improved, perhaps at my one year SVR anniversary.

 

This has been my thinking. I'm 11 wks post with a Fibroscan scheduled for the end of September. SVR or not, I would prefer a post-tx baseline going forward to monitor fibrosis progression/regression. The scans are affordable enough. I was thinking annually might not be a bad idea.

wayne



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66 y/o male - Geno 1b - F4 cirrhotic dx 2001 - 16 wk treatment w/ Sovaldi/Olysio/Riba - Und @ EOT+24 SVR

 
Gator Man


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I've now had two Ultrasounds and will continue every six months as directed. Even though there are more convenient locations, my doctor prefers that I stay with the same radiology facility. As noted, they will have my prior results readily accessible for comparison and my doctor indicated that he and the radiologists "are on the same page" for any liver imaging or biopsies.

There has been no mention of doing any other imaging going forward, just Ultrasounds every six months as the current SOC. The doctor is also not a believer in AFP testing for HCC monitoring.

Malcolm, should I suggest having an MRI down the road? Also, there are  no plans for getting a FibroScan at some milestone in the future unless I just want one. My doctor told me that he was more concerned with how I was doing clinically with cirrhosis symptoms and LFTs than anything else. The only three things I have to do going forward are continued Ultrasounds, abstain from alcohol and continue to drink coffee.

Do I insist on MRIs and/or FibroScans just to satisfy my curiosity? I think there is something to be said for knowing if fibrosis has improved, perhaps at my one year SVR anniversary.

 



-- Edited by Gator Man on Thursday 31st of July 2014 03:50:37 PM

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Geno 1b, compensated cirrhotic, 54 yo, prior null responder. Pre tx VL approx 595,000, tx with Sovaldi/Olysio (no Riba) started 1/8/14. VL 40 @ 2 weeks, UND @ 4 weeks. Still UND @ EOT + 1 year.

Gator Man SVR12, Dragon 0, Final Score.
Zlikster


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:) good to hear your liver is recovering...why not doing FibroScan bit more often? cheers!

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GT 3 dg. 08-2012 / FibroScan: 5 kPa F1 / FibroTest: F0-1 A1 / SoC TX: PegInt 120mcg+Riba 1000mg UND from w8 relapse EOT+4w
01-2016 Sof+Dac+Riba UND from w8, SVR24!
mallani


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Matt: The suggestion is that cirrhotics need 6 monthly imaging. As I've said, this is to find early HCC's (<1.5cm), as these are mostly likely to be cured by resection.

         I've traditionally been difficult to scan, because of the shape of my lower rib-cage. Some areas of my liver were difficult to see. However, today's exam. was pretty comprehensive. As Ultrasound is cheap, quick and 

         easy, this is most often requested. CT and MRI require IV contrast, and are expensive. I'll now just have Ultrasounds, with an MRI every 3rd time.

Isiscat: My LFT's are normal. I really didn't have any symptoms before treatment. My post-Rx problems were all Interferon related and these have completely resolved. I feel great.

           I don't intend to have another Fibroscan at this stage. Maybe in a year or two, I may be interested but I'm content knowing my fibrosis has partly resolved and won't get any worse.

Mike: Thanks buddy. I'd have MRI follow-ups of 'suspect lesions'. Hope you don't develop any more ascites.

 



-- Edited by mallani on Thursday 31st of July 2014 03:09:39 PM

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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Isiscat2011


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So, if the fatty changes are resolving and the fibrosis score improves, how does that translate in terms of how your liver is functioning now compared to before SVR?  Do you notice changes like these in your daily life?



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Isiscat2011


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Your liver is definitely seeing improvements, Malcolm.  That is encouraging news for all of us especially cirrhotics.  Well done.  

When do you have your next Fibroscan?



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Matt Chris


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 Hey Malcolm

Congrats on the good results, great to hear that the Ultrasound equipment is better.

Are you saying that Ultrasound should be the first choice then MRI if something is suspicious come up.

matt



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61 year old Geno type A1, F4 Cirrhotic, started 24 weeks on Harvoni 12-17-14 ,EOT-5 week = UND, 8-31-15 =UND , SVR-24 Baby YES! 
wmlj1960


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I correct myself - the paracentesis were CT, I think, I've also watched as they did liver ultrasound several times and I could not tell anything about what I was looking at. no



-- Edited by wmlj1960 on Thursday 31st of July 2014 04:33:32 AM

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60 yo, geno 1a, Dx 1994 HCV-HIV co-inf, Dx 2013 decompensated cirrhosis
Tx #1 - 24wks Sov+Riba /SOT 7-24-2014/UND@EOT/DETECTED@EOT+16 wks
Tx #2 - 24wks Harvoni /SOT 7-25-2015/UND@EOT,+12,+24,+52 = SVR

Mike

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wmlj1960


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Great news Malcolm!  I don't know much about what I'm looking at but I have a copy of the MRI I had done lately that found suspect lesions, and I've watched the ultra sound during all 3 of my paracentesis, and I can tell there is much more detail with the MRI.

I fuss about the high cost of medical care, but when a new technology that took lots of $ to produce comes out, (like that new Ultrasound machine), I tone down my fussing considerably. biggrin



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60 yo, geno 1a, Dx 1994 HCV-HIV co-inf, Dx 2013 decompensated cirrhosis
Tx #1 - 24wks Sov+Riba /SOT 7-24-2014/UND@EOT/DETECTED@EOT+16 wks
Tx #2 - 24wks Harvoni /SOT 7-25-2015/UND@EOT,+12,+24,+52 = SVR

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mallani


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Hi all,

Had another of my post-SVR imagings today. My old practice has a new GE Ultrasound machine, and I was very impressed.

I have always been fairly negative about Ultrasound, compared with CT or MRI, for finding small HCC's.  I want to be sure that a 10mm lesion is not missed. That is why I have had mostly MRI's.

I'm now prepared to change my opinion, provided the examination is done on a modern machine by a skilled Sonographer. If anything suspicious is seen, then I'd want an MRI.

Having imaging every 6 months is a pain, but for cirrhotics it's worth doing. Try to have it done at the same Radiology centre, and have the old films for comparison.

It's now 18 months since EOT, and I was interested to see how my liver looked, considering the improvement in Fibroscan score. It looks completely normal- apart from the small haemangioma and my gallstones. I know there's still a lot of fibrous tissue there, and it shows how poor Ultrasound is for assessing liver fibrosis. The liver texture is less bright indicating complete resolution of any fatty change.

So, I'm happy. Another one in 6 months. Cheers.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
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