Biopsy

A biopsy is one of the ways healthcare providers determine what’s going on in your body. In a biopsy, a provider removes samples of your tissue, cells or fluids so a medical pathologist can examine them for signs of disease. Providers may recommend biopsies to diagnose or monitor medical conditions or to plan treatment. A biopsy is invasive and carries some risks.

The purpose of the METAVIR score is to determine the level of fibrosis (scarring) of the liver. When a liver biopsy is performed, the METAVIR score provides a way to quantify what is seen under the microscope. The score takes into account both the degree of inflammation in the liver and the degree of fibrosis already present to give doctors an indication of how advanced the disease is, its prognosis, and when treatment should be considered.

The fibrosis score is used to describe the amount of inflammation (the intensity of inflammation/breakdown of tissue) in the liver:

• F0: No fibrosis

• F1: Portal fibrosis without septa

• F2: Portal fibrosis with few septa

• F3: Numerous septa without cirrhosis

• F4: Cirrhosis

The activity score is a prediction about how rapidly the degree of fibrosis is progressing:

• A0: No activity

• A1: Mild activity

• A2: Moderate activity

• A3: Severe activity

Quantitative Liver Spleen Scan

A liver and spleen scan is a nuclear medicine imaging test that looks specifically at your liver and spleen. These two organs occupy the upper parts of your abdomen. Conditions affecting one can often affect the other. The test uses a low dose radioisotope that’s injected into your body. How your organs absorb the material can tell your provider how those organs are functioning and highlight areas that might be damaged.

The problem with measuring just the stiffness due to scarring is that the liver regenerates and the body increases blood flow to the liver to get more function out of the remaining liver. Advanced software that accounts for the effects of regeneration and increased blood flow (HEPATIQ®) provides six indices of liver disease from a single liver and spleen scan: quantitative liver function, fatty liver disease/steatohepatitis, portal hypertension, alcoholic hepatitis, fibrosis stage and variceal size.

HEPATIQ also provides a physiologic stage (different from fibrosis stage) of liver disease:

• H0 Normal liver function.

• HA Acute liver disease likely.

• HS Steatotic liver disease likely.

• H1 Borderline liver function.

• H2 Steatotic cirrhosis likely.

• H3 Non-steatotic cirrhosis likely.

• H4 Liver decompensation likely.

• H5 Liver transplant candidate.

Elastography

Elastography is a test that uses low-frequency vibrations to check the elasticity of your body’s organs. When liver tissue lacks elasticity and are stiff, it may signal disease. Scar tissue in the liver causes stiffness. There are two main types of elastography: (1) Ultrasound: Also called transient elastography (FibroScan®), this test uses a handheld wand and sound waves to produce an image of your organs, and (2) Magnetic resonance: This test combines sound waves from an ultrasound with magnet and radio waves from an MRI to produce images of your organs.

Blood Tests

These measure different substances produced by your liver. These measurements give your healthcare provider information about the overall health of your liver. A liver panel will often measure several substances in one blood sample. It may include various enzymes, proteins and byproducts.