What Is a Fibrosis Score for Hepatitis C?

Medically Reviewed by Jennifer Robinson, MD on August 17, 2022
5 min read

The hepatitis C infection can inflame and damage your liver. Damage starts when scar tissue called fibrosis builds up in this organ.

As fibrosis gets worse, scar tissue takes the place of healthy tissue in your liver. Fibrosis can also stop blood from flowing through your liver as it should, making the healthy part work harder.

If scarring gets really bad, called cirrhosis, your liver can’t work as well.

These are all good reasons to know how much fibrosis is in your liver.

To help manage or prevent health problems from hepatitis C, such as liver cancer or liver failure, your doctor can measure the amount of fibrosis in your liver. This measurement is called a fibrosis score.

Your fibrosis score helps your doctor decide which treatments might help. With treatment, there’s a chance your liver can get better over time if your fibrosis isn’t too advanced.

Several tests can measure your fibrosis score. All of them can tell how much fibrosis and inflammation are in your liver.

Here’s what these tests are and what happens while you’re getting them:

Biopsy: A doctor looks at cells from your liver to figure out how damaged they might be.

How it’s done: You’ll lie flat on a table. Your doctor will find your liver by using an ultrasound machine or by feeling your belly. You might be given medicine to help you relax. The skin over your liver will be cleaned, and you’ll get a shot so you don’t feel pain from the biopsy needle. A long, thin needle is pushed into your belly to take tissue from your liver. This will be done in 10 or 15 spots to make sure enough cells have been taken from different areas. You may spend a few hours after the biopsy at the doctor’s office so you can be watched to make sure you feel well.

Elastography: This is a newer test that doesn’t need to take cells from your liver. There are two kinds:

FibroScan: This method uses ultrasound waves to measure fibrosis by how stiff your liver has become. The stiffer your liver is, the more fibrosis it has.

How it’s done: You lie on a table with the right side of your belly showing. A special gel is spread on your skin over the area of your liver. Your doctor will move a small wand over your belly. It doesn’t usually hurt and doesn’t take long.

Elastography with MRI: This approach uses pictures from ultrasound and magnetic resonance imaging (MRI) machines. Your doctor will make a special map using these pictures that shows how stiff your liver is.

How it’s done: You lie on a table, and a small pad is placed on your belly that carries vibrations through your liver. The table slides into an MRI machine shaped like a long tube. It uses strong magnets that move around you to get pictures of your organs and other structures inside your body. You might wear earplugs or headphones to help block loud noises from the machine. The test should take less than an hour.

You might not be able to have an MRI elastography test if you are pregnant or have devices made of metal inside your body. These devices include pacemakers, artificial heart valves, or pumps to push medicine into your veins. If you’re pregnant, the magnets in the MRI machine might hurt the baby or make the devices stop working right.

Blood test:Different kinds of blood tests can also measure fibrosis. One of them is called FibroSure. It measures six substances in your blood that are linked to fibrosis.

How it’s done: A health care worker will take blood from a vein in your arm using a needle. The needle is connected to a test tube that collects your blood sample.

After you have one or more tests, your doctor may tell you how much fibrosis is in your liver by telling you a “stage.” The higher the number, the more fibrosis you have. A fibrosis stage of 2 or higher means there’s a lot of fibrosis in your liver. If your fibrosis stage is 3 or 4, your fibrosis is advanced. You have cirrhosis if your fibrosis stage is 4.

Your doctor can also use results from your FibroScan test alone or combined with other tests to figure out your fibrosis score. FibroScan fibrosis scores cover five possible stages of liver damage, from none or mild all the way to severe cirrhosis. They are broken down into these groups:

F0 to F1: No scarring in your liver, or just a little.

F2: Some scarring, between a little and a lot.

F3: A lot of scarring.

F4: Cirrhosis.

FibroScan scores are estimates, meaning the measurements are not exact. Other health problems or things you do can make your score less accurate. These include tumors in your liver, heart failure, obesity, or drinking alcohol.

Once your doctor gets your fibrosis test results, they may decide to do more tests to be sure of your diagnosis. Some fibrosis measurements also combine blood test results with a special calculator tool to figure out your risk for fibrosis. These tests are called APRI and FIB-4. But these tests can only tell if you might have fibrosis, not what stage it is.

If your fibrosis score shows you have liver scarring that’s mild or moderate, you might be able to do things to stop scarring from getting worse. Sometimes fibrosis even gets better after hepatitis C treatment. Along with taking any medications your doctor prescribes for your hepatitis C, it also helps to eat healthy, avoid alcohol and other drugs, and exercise. If you’re not active now, ask your doctor what types of activities are best for you.