I’ve recently transitioned from using FibroScan to Shear Wave Elastography (SWE) for monitoring liver stiffness and fibrosis, and I’m a bit confused about how to interpret the kPa cut-off values, particularly in relation to my Hepatitis B status.
Background:
Gender: Female, 42 years old
Hepatitis B likely contracted at birth (from South China)
Hepatitis B genotype: Unknown (possibly B or C based on origin)
e-Antigen status: Negative
Past Highest Viral Load (HBV DNA): 458000 IU/mL
Viral Load (HBV DNA): 97,500 IU/mL
ALT: 15 U/L, AST: 19 U/L
Previous 2023 Fibroscan: 2 were preformed “IN DIFFERENT AREAS”. 9.2 kPa, second 5.1 kPa
Shear Wave Elastography: Median value of 8.53 kPa with an IQR/median of 14% (good data set)
Shear Wave Elastrography was preformed to compare with Fibroscan because there was a jump from F1 - F3. The internal specialist suggested it was because we were using a medium prob when she suspected a small was more suitable for my size. However in the past all Fibroscans were taken with a medium prob which were on average F0 - F1
According to my SWE results:
GE E10 ultrasound unit
F1: 5.48 – 8.29 kPa
F2: 8.29 – 9.4 kPa
F3: 9.4 – 11.9 kPa
F4 (cirrhosis): >11.9 kPa
Based on this, my fibrosis level falls into the F2 range. However, in the past, I’ve had experiences where doctors using FibroScan did not account for the specific kPa cut-offs for Hepatitis B (vs. Hepatitis C, where values differ).
I also came across some studies on Shear Wave Elastography in Chronic Hepatitis B (CHB) patients that suggested different cut-off values:
Mean cutoff value of 7.91 kPa for diagnosing ≥ F2 in overall CHB patients: This suggests that in CHB patients, significant fibrosis (≥ F2) is detected when liver stiffness exceeds 7.91 kPa.
Threshold of 7.15 kPa for diagnosing ≥ F2 in antiviral treatment-naïve CHB patients: For patients who haven’t started antiviral therapy, significant fibrosis may be detected at even lower values, starting at 7.15 kPa.
My Questions:
Are these cut-off values correct for Shear Wave Elastography in Hepatitis B patients?
Are there any situations (such as treatment or other health factors) where these cut-off values might vary?
Given my SWE result of 8.53 kPa, am I at the lower end of significant fibrosis (F2)?
Additionally, my doctor is an internal medicine specialist studying Hepatitis B under a hepatologist. They are suggesting that I wait for either higher ALT levels or an F3-F4 fibrosis score before considering treatment. However, as an e-antigen negative patient with a high viral load and low ALT, I’m concerned about the potential risks for liver injury or hepatocellular carcinoma (HCC). I’ve read that patients in this category can be in a grey area can sometimes have a higher risk of complications, even with low ALT. Waiting for severe Fibrosis or Cirrhosis makes be a bit uncomfortable and understanding how the cut off values will help me discus my concerns with my doctor better
I’m trying to ensure I fully understand my risks and options, so any insights you can provide would be greatly appreciated!
Hi @Althaea,
Welcome to the community and your concerns are valid. You are right about patients with e-antigen negatives. I think the consensus at least from what I have read is to start treatment even if these patients have normal LFTS and imaging. The risk of waiting to develop abnormal results could pose issues down the road. If you want to start treatment then I will still discuss this with my provider and if they still refuse, try and seek a second opinion from someone that actually treats hepatitis B. I hope this can help start a serious conversation with your doctor(s). It is your life and I think they need to listen to you more here about your valid concern(s). Others will chime in on the Fibroscan and Elastography numbers. Best, Bansah1
Thank you, @Bansah1, for your thoughtful response. I truly appreciate your reassurance, as I’ve been feeling somewhat dismissed by the pressures in our healthcare system. I recall coming across a post about Grey Zone patients here before, but I can’t seem to find it now through searches.
Do you happen to know where I could find the link to that post?
I’ll be making another post on the topic of “When to Start Treatment” after doing a bit more research. My goal is to bring more informed questions to my appointment next month, so I can start a meaningful conversation with my doctor and develop a plan that we’re both comfortable with.
Hi @Althaea,
I thought I had seen the post you are referring to. I have looked around but could not find it. Sorry about that. Great idea, don’t over do it. Best, Bansah1.
Just wanted to bump this in case it’s gone unnoticed. I’m still seeking clarification on the cut-off values for Shear Wave Elastography (SWE) in Hepatitis B patients. I know the best source is my specialist, but I like to double-check things like this. Any insights would be appreciated!
Hello
The SWE and FibroScan may not always show same results. The reading can be affected by the Ultrasound or technician operator / reader, even if you ate before taking the test (due to blood flow to the gut after eating)
If there is a lot of “inflammation” and elevated ALT the number can be elevated and not due to fibrosis or scarring
Since your ALT is normal (only 15) both SWE and FibroScan of F2 (stage 2) fibrosis appears valid (correct). Your viral load is ~97,000 IU/mL
I would talk to you internal medicine specialist about starting on antiviral therapy which can prevent further fibrosis development and improve current fibrosis
@cscoffin
Thank you for your informative response. I really appreciate your input and the reaffirmation to discuss treatment options with my specialist. I was also wondering, does SWE have different cutoff values for different conditions? For example, with FibroScan, the cutoff values differ between Hepatitis B and Hepatitis C to the best of my knowledge.
I don’t have an answer to your question, just a personal anecdote. When I got a fibroscan a few years ago, I was surprised to find it being in the severe liver fibrosis category. And then I did some reading and I took NAC (a gram or so per day) for one week, and I went for another scan. I was feeling a lot better after taking the NAC. And then when I had the fibroscan (just 1 week after the first), it showed no fibrosis at all. So you can make of that what you will. Personally, I think it was congestion and inflammation that was causing the high liver stiffness scores. In the future I would take NAC before a scan to try to actually measure the fibrosis vs congestion/inflammation
I really appreciate your insight, @bob! It’s responses like yours that brought me so much comfort when I first started researching. I’ve taken NAC before and genuinely believe it’s been beneficial for me. Recently, I started supplementing with “LipoMicel Glutathione,” which is encapsulated in a lipid membrane to help protect its integrity so it can reach the liver more effectively.
This post is actually a bit of a prelude to another one I just made. Feel free to check it out if you’re interested!
Before diving into that, I really wanted to get a better understanding of the correct kPa cutoff values for SWE.
