Test · Liver assessment
FibroScan
FibroScan is a short scan, done from outside the body, that measures how stiff the liver is and how much fat it contains. Stiffness reflects scarring, which is the finding that matters most in fatty liver and hepatitis. The test takes about ten minutes, uses no needles, and gives a result on the spot.
At a glance
What it measures
Liver stiffness (scarring) and liver fat.
Time taken
About 10 minutes.
Preparation
No food for three hours beforehand.
Results
Available immediately and explained at the same visit.
What is a FibroScan?
FibroScan is the common name for a test called transient elastography. A probe placed on the skin over the liver sends a gentle pulse through it and measures how fast the pulse travels. The pulse moves faster through stiff, scarred tissue than through a healthy, soft liver.
The same probe measures how much the ultrasound signal is weakened by fat. The test therefore gives two numbers:
- Liver stiffness, in kilopascals (kPa), which reflects scarring
- CAP score, in decibels per metre, which reflects fat
An ordinary ultrasound shows that fat is present. It does not show reliably whether the liver is scarred. FibroScan answers that question.
When do I advise a FibroScan?
Fatty liver
When a simple risk score from your blood tests is not clearly low. See fatty liver.
Type 2 diabetes with raised liver enzymes
Diabetes makes liver scarring more likely.
Hepatitis B or C
To judge the degree of liver damage and to guide treatment.
Regular alcohol use
To detect scarring early.
Follow-up
To see whether weight loss and treatment are improving the liver.
How do I prepare?
- Food: do not eat for three hours before the test. A recent meal increases blood flow to the liver and can raise the reading. Water is allowed.
- Alcohol: avoid it for at least a few days beforehand.
- Clothing: wear a loose top that can be lifted to expose the right side of the lower chest.
- Tell the team if you are pregnant or have a pacemaker or another implanted device.
What happens during the test?
You lie on your back with your right arm raised behind your head. A little gel is applied, and the probe is placed between the ribs on the right side. You feel a light tap each time a reading is taken. Ten readings are collected, which takes a few minutes. There is no pain and no sedation.
Afterwards and results
You can leave at once and eat normally. I explain the result at the same visit.
For fatty liver, stiffness is read broadly as follows:
| Liver stiffness | What it suggests |
|---|---|
| Under 8 kPa | Significant scarring is unlikely |
| 8 to 12 kPa | Uncertain; a second test or a repeat scan is advised |
| Over 12 kPa | Advanced scarring is likely and needs specialist follow-up |
These cut-offs differ for other liver conditions, and one number is never read in isolation. Active inflammation, a recent meal, heart failure and a blocked bile duct can all raise stiffness temporarily. I interpret the reading alongside your blood tests and ultrasound.
What happens after the result?
- Low stiffness: treatment focuses on weight, food, exercise and metabolic health, with a repeat scan in one to three years.
- Intermediate stiffness: a second kind of test, or a repeat scan after a few months of treatment.
- High stiffness: further assessment for cirrhosis, including an endoscopy and six-monthly ultrasound scans.
What are the risks?
There are none known. The test uses ultrasound and involves no radiation. It can be difficult to obtain readings when there is fluid in the abdomen or a great deal of tissue over the ribs; a different probe or a different test is then used.
Questions patients ask me about FibroScan
Is FibroScan painful?
No. You feel a light tapping on the skin. There are no needles.
Does it replace a liver biopsy?
For most people, yes. A biopsy is now reserved for the few in whom the scan and blood tests disagree or another diagnosis is suspected.
How is it different from an ultrasound?
An ultrasound shows the shape of the liver and whether fat is present. FibroScan measures stiffness, which indicates scarring, and gives a number that can be followed over time.
How often should it be repeated?
Every one to three years in fatty liver without significant scarring, and sooner when the reading is borderline or treatment has been started.
Do I need to fast?
For three hours. Eating shortly before the test can give a falsely high reading.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- American Association for the Study of Liver Diseases practice guidance on fatty liver disease. Rinella ME et al. Hepatology. 2023. PubMed 36727674
- European guideline on metabolic dysfunction-associated steatotic liver disease (MASLD). EASL, EASD, EASO. J Hepatol. 2024. PubMed 38851997
- Indian National Association for Study of the Liver guidance on fatty liver disease. Duseja A et al. J Clin Exp Hepatol. 2023. PubMed 36950481