Liver stiffness by transient elastography is compared against a previous value more often than against a threshold, so the reproducibility of the measurement is the whole point. A postprandial liver is stiffer, and the effect is large enough to invent a fibrosis stage that is not there.
So fix the conditions before you read the number. At least three hours fasted, patient supine with the right arm fully abducted, and the intercostal space chosen by palpation rather than by where the probe happens to fit. Record the interquartile range as a proportion of the median: above 30% the reading is unreliable and should be repeated, not reported.
The other habit worth building is writing the probe size in the report. An M probe used where an XL was needed reads high, and the next clinician comparing two values two years apart has no way to know unless it is written down.
- Three hours fasted, minimum - a postprandial reading can shift a patient a whole fibrosis stage
- Reject any reading with an interquartile range above 30% of the median and repeat it
- Write the probe used (M or XL) in the report so future comparisons are like for like
- Check for ascites and right heart failure before attributing a high reading to fibrosis
- Compare serial readings from the same machine where possible; between-device differences are real
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