Are your organs feeling a little tight inside? Let's talk about Elastography!

Have you ever wondered how great it would be if there was a way to know for sure whether the vital organs inside our bodies, like the liver and kidneys, were healthy and flexible? That is, if we could take care of these things without surgery or much discomfort? That is what this test called elastography does. Let's talk about this simply, in a way that you can understand.

What is elastography, simply put?

Simply put, elastography is a painless test that measures the flexibility, or "springiness," of organs in our bodies, such as the liver. Imagine, when we choose a fruit, we squeeze it a little with our hands to see if it's firm or spongy? This is the same thing, but with much more advanced technology.

This test uses low-frequency vibrations. These vibrations are sent through our organs and measure their stiffness. Because sometimes, if the tissues of our organs become unnecessarily stiff, that is, if their flexibility decreases, it can be a sign of some disease. This stiffness is an important indicator, especially in liver-related diseases.

Are there types of elastography?

Yes, there are mainly two types of elastography.

1. Ultrasound Elastography (Elastography Ultrasound) or FibroScan®

This is also called transient elastography by some. You may have heard of FibroScan®. That's what it is. It's really like a specialized ultrasound test .

• In this, a small hand-held device (a `transducer`) and sound waves are used to obtain an image of your organs.
• This is not painful at all, and it's very quick. It's something that can be done in a flash.

2. M.R. Elastography (MRE - Magnetic Resonance Elastography)

This involves combining the sound waves from an ultrasound with the magnets and radio waves from an MRI (Magnetic Resonance Imaging) scan to obtain clear images of your organs.

• The most important thing is that no radiation is used in this.
• Sometimes the doctor may decide to do this MRE test alone, or it may be done in conjunction with a full MRI scan.

What is this 'shear wave' elastography?

This is a new ultrasound technology. It is also used to measure the stiffness of the tissues of the organs.

• Remember that handheld device (the `transducer`)? It sends out high-intensity pulses. These pulses create a special type of wave called `shear waves`.
• These shear waves allow for very high-quality, clear images .
• Although this technology is still developing, it is already being used for some ultrasound examinations. For example:
• Breast-related tests
• Liver
• Musculoskeletal system
• Prostate
• Check for thyroid nodules.

So, why is this elastography test done?

The main and most common reason for doing this test is to see if your liver has a condition called fibrosis, or `fibrosis`. This fibrosis is simply scarring of the liver. This can occur in the early stages and, if not treated properly, can eventually lead to a serious condition called `cirrhosis`.

If you have risk factors for cirrhosis, or if you are showing symptoms of the disease, your doctor may recommend an elastography test.

Important: Fibrosis can reduce the amount of blood that passes through the liver. Over time, that blood can start to pool behind the liver. If this is not treated properly, it can cause serious health problems.

Such problems are:

• Cirrhosis
• Liver cancer
• Liver failure
• Gastrointestinal bleeding

Therefore, elastography is a great help for doctors to decide what kind of treatment is appropriate for liver fibrosis. Not only that, if you are taking treatment, this test can also help to see how your liver is responding to those treatments and predict the possibility of complications such as fatty buildup in the liver.

Who performs these elastography tests?

Elastography Ultrasound and MRE are performed by a radiologist , a doctor who specializes in medical imaging technology. They usually work closely with your primary care provider, oncologist, and hepatologist.

How accurate is liver elastography?

Although there are various studies on this, most doctors agree that elastography is a very accurate test for diagnosing liver fibrosis. In fact, many doctors use this test to diagnose this condition. More importantly, it is also used to monitor how the disease is getting worse or controlled over time.

How is this elastography test performed?

The way this is done varies slightly depending on the type of test.

How to perform Transient Elastography:

This only takes a few minutes. Very quick.

• First, the radiologist will apply a water-based gel to the area of ​​your skin that will be examined. This will allow the handheld device (the `transducer`) to move easily over the skin.
• The radiologist then moves the transducer over your skin to find the exact location of the organ to be examined.
• Now, that transducer sends painless, low-frequency vibrations into the body.
• These vibrations hit the relevant organ and are reflected back. That information goes to a computer.
• The computer uses this information to create an `image` of the relevant organ.
• By looking at this image, the radiologist can see exactly what the organ is like, its size, shape, and its condition – that is, how firm it is, whether it is filled with fluids, etc.

How to do an MRE:

An MRE usually takes about 5 minutes. However, if you're doing it with a full MRI scan, it can take a little longer, about 45 minutes. Here's what happens when you get an MRE:

• You will be made to lie down on a table. You may also be given straps to help keep you still.
• A small device, called a `driver`, is placed under the skin on the right side of your chest, just below (if you are doing an MRE of the liver).
• There are other devices, which can send and receive radio waves, that are located next to the `driver`.
• If you are given a contrast agent (a special liquid, such as gadolinium) for an MRI, it will be injected through an IV line placed in a vein in your arm.
• Then you're sent into the MRI machine. It's a machine that looks like a little tube.
• The radiologist controls all of this outside the MRI machine, sitting at a computer.
• The driver sends small vibrations to your liver, and while it takes images of it, you are asked to hold your breath for a few seconds.

How do you prepare for this?

Here are some things you should consider before having an elastography test:

• Food: Avoid sugary foods and drinks before the test. Sugary foods can affect the liver's ability to function. You may be asked to fast for a few hours before the test. Therefore, it is best to ask your doctor exactly how long you should fast.
• Clothing: On the day of the test, leave your jewelry, watches, hairpins, hearing aids, and removable dentures at home. Wear comfortable, loose-fitting clothing. You may also be asked to wear a medical gown provided by the hospital.
• Metal: If you have any metal objects inside your body – such as bullet fragments, old-style cardiac defibrillators or pacemakers – you should definitely tell the radiologist about them, as these metal objects can interfere with the magnetic field of the MRI machine.
• Pregnancy: If you are pregnant, be sure to tell your doctor and radiologist. Elastography is generally considered safe during pregnancy. However, it is best to avoid MRI scans during the first trimester. However, MRI scans can be performed during this time only if your doctor determines that the benefits of the scan outweigh the risks.

What kind of experience did you have during the test?

Your radiologist will explain everything to you during the test. Both Elastography Ultrasound and MRE are painless, noninvasive tests. So you won't feel any pain or discomfort.

If you're having an MRE, you'll have to stay in the tube-like space for a few minutes. If you're having a full MRI, it takes a little longer, about 45 minutes. If you have claustrophobia, tell your doctor and radiologist beforehand. Also, be prepared to hold your breath for about 10-15 seconds during the MRE.

Are there any risks in this?

• Elastography ultrasound does not pose any risks as far as has been discovered.
• When having an MRE, if proper safety procedures are followed, there is no risk to the average person. The magnetic field is not harmful. However, if you are given a drug to make you sleepy (`sedation`), there may be risks associated with giving too much of that drug. Also, there is a very small chance of having an allergic reaction to the `contrast` fluid called `gadolinium`, which is used only for some MRI tests.

What kind of results are obtained? What do they tell us?

Your elastography test takes an image of your liver. The radiologist can use the image to tell you how stiff your liver is. This stiffness is a measure of how much scarring there is in your liver. The degree of scarring can range from mild to severe:

• F0 to F1: None or mild scarring.
• F2: Moderate scarring.
• F3: Severe scarring.
• F4: Very severe scarring, which is cirrhosis. (Advanced scarring)

How long does it take to know the results?

The radiologist will determine the results of your elastography scan within a few days. They will share the results with the other doctors who referred you. Then, one of your doctors will call you to explain the results and answer any questions you may have.

In summary (Take-Home Message)

Elastography is a noninvasive test that measures the stiffness of the tissues inside our bodies. It is often used to check for liver fibrosis, a condition that causes scarring in the liver. Your doctor may order this test if you have inflammation or damage to your liver, or if you have symptoms of cirrhosis.

This test is usually quick and painless, so there's nothing to worry about. If you want to know more about this, talk to your doctor and ask for more information. That way, you can clear up any questions you may have.

` Elastography, Liver Stiffness, Fibrosis, Cirrhosis, Ultrasound Scan, MRE, FibroScan, Liver Disease, Diagnosis, Painless Tests