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FibroTouch Examination Report - Complete Interpretation & Teaching
What Is This Test?
This is a FibroTouch Examination Report - a non-invasive ultrasound-based device that simultaneously measures two things about the liver:
- Liver Stiffness (how fibrous/scarred the liver is)
- UPA - Ultrasound Attenuation Parameter (how fatty the liver is)
It's in the same family as FibroScan (transient elastography). The liver is assessed without a needle, making it safe, fast, and repeatable. As Sleisenger & Fordtran's GI and Liver Disease describes, transient elastography "correlates with the amount of hepatic fibrosis" and in meta-analysis achieved an AUROC of 0.94 for predicting cirrhosis.
Patient Details
| Field | Value |
|---|---|
| Name | Fayis |
| Age | 43 |
| Date | 14/08/2026 |
| Report No. | 61 |
Reading 1: Liver Stiffness Measurement (LSM)
The Result
| Parameter | Value |
|---|---|
| Median Stiffness | 5.3 kPa |
| IQR/Median ratio | 8% |
| Success Rate | 100% (10/10 valid shots) |
The Scale (from the report)
< 7.3 kPa → F0-F1 ✅ NORMAL / NO SIGNIFICANT FIBROSIS
7.3–9.7 → F2 Mild fibrosis
9.7–12.4 → F2-F3 Moderate fibrosis
12.4–17.5 → F3-F4 Advanced fibrosis
> 17.5 kPa → F4 CIRRHOSIS
Interpretation of 5.3 kPa
Fayis falls in F0-F1 - completely normal liver stiffness. There is no significant fibrosis. The liver tissue is soft and pliable, as it should be.
Why Does Fibrosis Increase Stiffness?
Healthy liver tissue is soft. When the liver is repeatedly injured (by alcohol, viral hepatitis, NASH, etc.), the repair process lays down collagen scar tissue (fibrosis). Scar tissue is stiff. More fibrosis = stiffer liver = higher kPa reading. The device measures how fast a shear wave travels through liver tissue - faster wave = stiffer tissue = more fibrosis.
Quality Check - IQR/Median = 8%
This is excellent reliability. An IQR/Median ratio below 30% means the 10 individual measurements were very consistent with each other. A ratio above 30% would make the result unreliable. At 8%, these results are highly trustworthy.
Reading 2: Ultrasound Attenuation Parameter (UPA)
The Result
| Parameter | Value |
|---|---|
| Median UPA | 210 dB/m |
| IQR/Median ratio | 18% |
The Scale (from the report)
< 244 dB/m → Normal ✅ NO STEATOSIS
244–269 → Mild fatty liver (S1)
269–296 → Moderate fatty liver (S2)
> 296 dB/m → Severe fatty liver (S3)
Interpretation of 210 dB/m
Fayis's UPA is in the normal range - no significant fat in the liver. No hepatic steatosis is detected.
How Does This Measure Fat?
Ultrasound waves lose energy (attenuate) as they pass through tissue. Fat attenuates ultrasound more strongly than normal liver parenchyma. The more fat droplets packed into liver cells (steatosis), the more the ultrasound signal fades - and the higher the dB/m value. A fatty liver acts like a sponge that absorbs sound energy.
Overall Summary for Fayis (Age 43)
| Test | Result | Reference | Meaning |
|---|---|---|---|
| Liver Stiffness | 5.3 kPa | < 7.3 = F0-F1 | Normal - No fibrosis |
| Fatty Liver (UPA) | 210 dB/m | < 244 = Normal | No fatty liver |
| Measurement Quality | 10/10, IQR 8%/18% | IQR < 30% = reliable | Excellent reliability |
Both parameters are normal. As of this test, Fayis has:
- No liver fibrosis or cirrhosis
- No fatty liver disease
- A technically reliable study
Important Clinical Teaching Points
1. Why Is This Test Done?
It screens for chronic liver disease - most commonly from:
- NAFLD/NASH (metabolic/fatty liver disease)
- Chronic hepatitis B or C
- Alcohol-related liver disease
- Any cause of progressive fibrosis
2. Fibrosis Stages (METAVIR System)
The F-staging used in the report follows the METAVIR system:
- F0 = No fibrosis
- F1 = Portal fibrosis without septa
- F2 = Few septa
- F3 = Many septa without cirrhosis
- F4 = Cirrhosis
3. Limitations to Know
- Liver inflammation (high ALT/AST) can falsely elevate liver stiffness, making fibrosis look worse than it is. The Yamada's Gastroenterology textbook notes that "LSM is most reliable in patients with normal or minimally elevated ALT because inflammation can increase liver stiffness, leading to falsely high LSM."
- It does not replace biopsy in all situations - it cannot assess the degree of inflammation.
- Obesity can sometimes reduce technical quality (though this test showed 10/10 success).
- Recent food intake, right heart failure, and cholestasis can also falsely raise LSM.
4. Stiffness vs. Fat - Two Different Problems
Fibrosis and steatosis are separate pathological processes. A patient can have:
- High fat + low fibrosis (early NAFLD)
- Low fat + high fibrosis (burnt-out NASH or viral hepatitis)
- Both high (advanced NASH/NAFLD)
FibroTouch measures both simultaneously, which is its clinical advantage.
Bottom line: This is a reassuring, normal liver assessment. Both liver stiffness (5.3 kPa, F0-F1) and liver fat content (210 dB/m, normal) are within the healthy range, with a technically excellent study. The patient should follow up with their physician to discuss these results in the context of their full clinical picture.
Sources: Yamada's Textbook of Gastroenterology, 7e - Assessment of liver disease; Sleisenger & Fordtran's GI and Liver Disease - Liver Biopsy and Noninvasive Assessment of Fibrosis
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This is the same FibroTouch report I already analyzed for you! Here's the full interpretation again for easy reference:
FibroTouch Examination Report - Interpretation & Teaching Guide
What Is This Test?
FibroTouch is a non-invasive ultrasound-based device that scans the liver in seconds and measures two completely separate things at once:
| What It Measures | Why It Matters |
|---|---|
| Liver Stiffness (kPa) | Detects fibrosis/scarring |
| Ultrasound Attenuation Parameter - UPA (dB/m) | Detects fat in the liver |
No needle. No biopsy. No pain. Results in minutes.
Patient Information
| Field | Value |
|---|---|
| Name | Fayis |
| Age | 43 |
| Date | 14/08/2026 |
| Report No. | 61 |
RESULT 1 - Liver Stiffness Measurement (LSM)
Numbers
| Median Stiffness | 5.3 kPa |
| IQR/Median | 8% |
| Valid shots | 10/10 (100% success) |
Reference Scale (on the report)
< 7.3 kPa ......... F0–F1 ✅ No / Minimal fibrosis ← FAYIS IS HERE
7.3–9.7 kPa ...... F2 Mild fibrosis
9.7–12.4 kPa ..... F2–F3 Moderate fibrosis
12.4–17.5 kPa ..... F3–F4 Advanced fibrosis
> 17.5 kPa ......... F4 Cirrhosis
✅ Verdict: NORMAL
At 5.3 kPa, Fayis is well within the F0-F1 (normal) zone. The liver is soft - no significant scarring.
🎓 Teaching: Why Does Fibrosis Make the Liver Stiff?
A healthy liver is soft, like a ripe grape. When the liver is repeatedly injured (by viruses, alcohol, fat, etc.), the body tries to repair damage by laying down collagen fibers - scar tissue. Scar tissue is stiff.
The device sends a mechanical vibration + ultrasound pulse into the liver. The shear wave travels faster through stiff tissue. The device calculates:
Faster wave → Stiffer liver → More fibrosis → Higher kPa
The METAVIR staging system (F0 to F4) is the international standard:
| Stage | Meaning | Typical kPa |
|---|---|---|
| F0 | No fibrosis | < 6 |
| F1 | Mild portal fibrosis | 6–7.3 |
| F2 | Few fibrous septa | 7.3–9.7 |
| F3 | Many septa, no cirrhosis | 9.7–12.4 |
| F4 | Cirrhosis | > 17.5 |
RESULT 2 - Ultrasound Attenuation Parameter (UPA)
Numbers
| Median UPA | 210 dB/m |
| IQR/Median | 18% |
Reference Scale (on the report)
< 244 dB/m ........ Normal ✅ No steatosis ← FAYIS IS HERE
244–269 dB/m ...... Mild S1 fatty liver
269–296 dB/m ...... Moderate S2 fatty liver
> 296 dB/m ......... Severe S3 fatty liver
✅ Verdict: NORMAL
At 210 dB/m, there is no significant fat accumulation in the liver.
🎓 Teaching: How Does Ultrasound Detect Fat?
Ultrasound waves lose energy (attenuate) as they travel through tissue. Fat droplets scatter and absorb sound more aggressively than normal liver cells.
More fat → More attenuation → Higher dB/m value
Fat builds up inside liver cells (hepatocytes) in a condition called hepatic steatosis, graded S0 to S3:
| Grade | Fat content | UPA range |
|---|---|---|
| S0 | < 5% of cells | < 244 dB/m |
| S1 Mild | 5–33% | 244–269 |
| S2 Moderate | 33–66% | 269–296 |
| S3 Severe | > 66% | > 296 |
IQR/Median Ratio - The Quality Indicator
Both results include an IQR/Median % - this tells you how consistent the 10 individual measurements were:
| IQR/Median | Meaning |
|---|---|
| < 30% | ✅ Reliable result |
| ≥ 30% | ⚠️ Unreliable - repeat test |
- Stiffness IQR = 8% → Excellent reliability
- UPA IQR = 18% → Excellent reliability
This is a technically perfect study.
Overall Summary
| Test | Fayis's Result | Normal Cut-off | Conclusion |
|---|---|---|---|
| Liver Stiffness | 5.3 kPa | < 7.3 kPa | ✅ No fibrosis (F0-F1) |
| Liver Fat (UPA) | 210 dB/m | < 244 dB/m | ✅ No steatosis |
| Study Quality | 10/10, IQR 8%/18% | IQR < 30% | ✅ Highly reliable |
Both the liver's structural health (no scarring) and metabolic health (no fat) are completely normal. This is a reassuring result for a 43-year-old.
⚠️ Key Limitations to Always Remember
- Inflammation inflates stiffness - If ALT/AST are elevated, the liver may read stiffer than its true fibrosis stage. Always correlate with liver enzymes.
- This test does not measure inflammation - only structural fibrosis and fat.
- Recent food (within 2 hours), right heart failure, and cholestasis can falsely raise LSM.
- The report itself says: "For reference only - please consult your physician for further diagnosis."
Sources: Yamada's Textbook of Gastroenterology 7e; Sleisenger & Fordtran's GI and Liver Disease
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