Elastography test: Everything you need to know without fear

Has your doctor told you to have a new type of scan? It might be called 'Elastography'. The name may sound a bit strange, but it's actually a very simple, painless, and very important test. It's like an ultrasound scan. So let's not be afraid of this, and let's talk about everything simply.

What is Elastography simply?

Simply put, Elastography is a test that measures the "elasticity" or softness/stiffness of organs in our body, such as the liver. It uses low-frequency vibrations that are painless and very small and cannot be felt by us.

Think of it this way. A healthy liver is like a new sponge that has soaked up water. It is soft and flexible. But when the liver is damaged by a disease, it gradually begins to harden and become stiff. It is as if the sponge has dried out and turned into stone. Elastography measures exactly how stiff it is. If an organ is too stiff, it may be a sign of a disease.

What are the main types of this test?

There are two main types of elastography. Your doctor will choose the type that is best for you.

What is Shear Wave Elastography?

This is another new method that comes from Ultrasound technology. In this, another special type of wave (shear waves) is used to measure the stiffness of tissues. This results in a clearer image. Although this technology is still being developed, it is already used to examine things like breasts, liver, muscles, prostate, and thyroid nodules.

Why do you recommend doing this Elastography test?

The main reason for performing an elastography test is to check for a condition called liver fibrosis .

Imagine that our liver is continuously damaged due to various reasons (for example, excessive alcohol consumption, hepatitis virus, fatty liver). Then the liver tries to heal itself. During this healing process, just like a scar forms when a wound on our skin heals, scar tissue forms in the liver. This is what we call Fibrosis .

As this fibrosis progresses, it interferes with blood flow through the liver. If left untreated, the liver can become completely stiff and shrunken, leading to a condition called cirrhosis . This can lead to serious health problems such as liver cancer and liver failure.

So, if you are at risk of developing liver disease (e.g. fatty liver, hepatitis) or are showing symptoms of similar diseases, your doctor may recommend an Elastography test. It:

• You can know exactly what level of fibrosis you have.
• Accordingly, you can decide what is the best treatment to give you.
• It is possible to monitor how the liver responds to the treatments given.

Who does this test? How accurate is it?

This test is usually performed by a radiologist , a doctor who specializes in medical imaging. He or she will work with your family doctor and a hepatologist to make decisions about your treatment.

This test is considered to be highly accurate in diagnosing liver fibrosis. In the past, a biopsy was required to accurately diagnose this condition. However, thanks to Elastography, this information can now be obtained without any pain or harm to the body.

How to do the test step by step

The way you do this will vary slightly depending on the type you were prescribed.

How to perform Transient Elastography (Ultrasound):

This will only take a few minutes.

1. First, the radiologist will apply a water-like gel to your skin, in the area where your liver is (on the right side of your abdomen, under your ribs). This will allow the scanning device to move easily over your skin.

2. Then, a small handheld device (transducer) is placed on the area and moved slowly back and forth.

3. This device sends a small shock to the liver that we cannot feel.

4. The speed at which the shock waves hit the liver and are reflected back is measured by a computer. As the liver becomes stiffer, the speed at which these waves travel increases.

5. Using this information, the computer measures the stiffness of the liver and displays it as an image.

How to do MRE (Magnetic Resonance Elastography):

This usually takes about 5 minutes, but if done with a full MRI, it can take about 45 minutes.

1. You will be laid out on a table. You may be given support such as straps to help you stay still.

2. There is a small device (driver) in the lower right part of your chest (above the liver).

3. Several other devices that send and receive radio waves are placed on the skin nearby.

4. Sometimes (not always) a small cannula is inserted into a vein in your arm and a special liquid (contrast - gadolinium) is injected through it. This makes the images clearer.

5. Then the table you are on will slowly move into the MRI machine, which looks like a large tube.

6. The radiologist sits at a computer outside the machine and controls the exam.

7. You will be asked to hold your breath for a few seconds. At that time, the driver will send small vibrations to the liver and take images.

How should you prepare before the test?

It is very important to follow the instructions your doctor gives you before your elastography test. Typically, you can expect things like:

• Food: Do not eat or drink anything sweet (sweetened tea, coffee, soft drinks, fruit juice) before the test. Sugar can slightly alter the liver stiffness measurement. You may be asked to fast for a few hours before the test. Ask your doctor for specific instructions.
• Clothing: Leave your jewelry, watches, and hairpins at home on the day of the test. Wear loose, comfortable clothing. You may need to wear a special gown provided by the hospital.
• Metal objects (for an MRE): If you have any surgically implanted metal objects (e.g. pacemakers, hearing aids, artificial joints), be sure to inform the radiologist in advance. These may be affected by the strong magnetic field of the MRI machine.
• Pregnancy: Tell your doctor and radiologist if you are pregnant or suspect you are pregnant. Ultrasound elastography is safe during pregnancy. However, MRI scans are not usually done during the first trimester of pregnancy.

What kind of risk is there in this?

MRE is generally safe if you follow the safety instructions carefully. The magnetic field is not harmful to the body. However, in rare cases, an allergic reaction to the contrast agent (gadolinium) used may occur. Also, if you are given a sedative to calm you down during the test, there may be risks associated with an overdose. However, these are very rare.

What do the test results say?

Your Elastography test produces an image of your liver. The radiologist analyzes the image to determine the degree of stiffness, or scarring, of your liver. This level is usually graded from F0 to F4.

Within a few days of the test, the radiologist will prepare a report of the results and forward it to your treating doctor. The doctor will then call you back to explain the results to you and discuss what needs to be done next.

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