A FibroScan is a quick, painless scan that measures how stiff your liver is and how much fat it contains. It has largely replaced liver biopsy for checking scarring. This guide explains why you might have one, how to prepare, what happens, and how to understand your numbers.
Key points
- A FibroScan works a little like an ultrasound. A probe on your skin sends a gentle pulse through the liver and measures how fast it travels.
- It gives two numbers: liver stiffness in kilopascals (kPa), which rises with scarring, and a fat score (CAP) in dB/m.
- It takes about 10 minutes and doesn’t hurt. You’ll usually be asked not to eat for about 3 hours beforehand.
- A low stiffness reading makes significant scarring unlikely.
- Results are always interpreted alongside your blood tests and history, not on their own.
What is a FibroScan?
FibroScan is the brand name for a test called transient elastography. Healthy liver tissue is soft. As scar tissue (fibrosis) builds up, the liver becomes stiffer, and a gentle pulse travels through it faster. The machine measures this speed and turns it into a stiffness score.[2,4] At the same time, it estimates how much fat is in the liver.
Why you might have a FibroScan
- fatty liver disease (MASLD), to check for scarring[3,5]
- abnormal liver blood tests, or a blood test score (such as FIB-4) that isn’t low[4,5]
- hepatitis B or C, or regular heavy drinking[4]
- to monitor a known liver condition over time
Before the scan
- Don’t eat for about 3 hours before. Small sips of water are usually fine, but avoid fizzy drinks. Eating makes the liver stiffer for a while and can push the reading up.[1,2]
- Keep taking your usual medicines. If you have diabetes, eat and drink as normal and tell the team.[1]
- Wear separate top and bottom clothes, so you can uncover the right side of your tummy easily.[2]
What happens
- You lie on your back with your right arm raised above your head.
- Gel is put on the skin over your lower right ribs.
- The probe is placed between your ribs. Each measurement feels like a gentle flick or vibration on the skin.[2]
- At least 10 readings are taken, and the machine works out the average.[1]
- It usually takes 5 to 15 minutes, sometimes longer if readings are harder to get.[2]
The result appears straight away, so you’ll often be told your numbers at the appointment. Sometimes they’re sent to the clinician who asked for the scan first.[1,2]
Understanding your results
Liver stiffness (kPa)
Healthy livers are soft, and results can range from 1.5 to 75 kPa.[2] Higher readings suggest more scarring. As a rough guide in people with fatty liver disease:[4,5]
| Reading | What it usually means |
|---|---|
| Below about 8 kPa | Significant scarring is unlikely |
| About 8 to 12 kPa | A grey zone: some scarring is possible, and you may need another test or a specialist review |
| Above about 12 kPa | Advanced scarring is more likely, although it doesn’t usually mean cirrhosis. You’ll usually be referred to a liver specialist for closer monitoring |
These cut-offs vary with the cause of liver disease and the machine used, and no single number confirms or rules out a liver condition.[2,4] Your clinician will explain what your number means for you, so don’t rely on ranges you find online.
Fat score (CAP, dB/m)
The controlled attenuation parameter (CAP) estimates how much fat is in the liver. Higher numbers mean more fat.[4] It’s useful for tracking change over time, for example after weight loss, but it’s less important than stiffness for deciding what happens next.
Look at the stiffness first
I carry out FibroScans, and I always tell people that the stiffness number is the one that matters most.
A high fat score with a low stiffness score is very common. It means there’s fat in the liver but no significant scarring yet, and that’s exactly the stage where changes to weight, activity and alcohol work best.
When there’s fat but no significant scarring, we often discharge people back to their GP, because it can be safely managed there. We give the GP team clear advice on when to refer you back, and suggest a repeat blood test score, such as FIB-4, in a year or two to check how things are going.
If your stiffness is raised, it isn’t a diagnosis of cirrhosis on its own. It means we need to look more closely, sometimes with a repeat scan or other tests, before drawing conclusions.
Ben JohnsonAdvanced Clinical Practitioner, Gastroenterology
Things that can affect the reading
- eating shortly before the scan
- active inflammation, for example from recent heavy drinking or hepatitis, which can raise stiffness temporarily
- heart failure or a blocked bile duct
- a lot of tissue over the liver, although a larger probe is often used
If a result doesn’t fit with everything else, your team may repeat it or use another test, such as the ELF blood test recommended by NICE.[3,4]
What happens next
- Low stiffness: you’ll usually be looked after by your GP, with advice on weight, activity and alcohol, and a repeat check in a few years.[3,5]
- Raised stiffness: you’ll usually be referred to a liver specialist for further tests and monitoring.[3,5]
- Very high stiffness: your specialist may arrange regular ultrasound scans and other checks, such as a gastroscopy.[5]
Frequently asked questions
Does a FibroScan hurt?
No. It feels like a light flick on the skin.
Do I need someone with me?
No. There’s no sedation, and you can drive and go back to work straight away.
Can my score improve?
Yes. Weight loss, less alcohol and better diabetes control can reduce both the fat score and, over time, liver stiffness. See our guide to fatty liver disease.
Is a FibroScan the same as an ultrasound?
No. An ultrasound makes a picture of the liver. A FibroScan measures stiffness and fat but doesn’t produce a picture. You may have both.
Having other tests too? Our tests and procedures guides explain what to expect from each one, including gastroscopy and colonoscopy.
References
- Royal Devon University Healthcare NHS Foundation Trust. FibroScan (patient information). https://www.royaldevon.nhs.uk/media/lcbep2ae/fibroscan.pdf
- British Liver Trust. Having a TE scan (FibroScan). https://britishlivertrust.org.uk/?p=69295
- NICE. Non-alcoholic fatty liver disease (NAFLD): assessment and management (NG49). https://www.nice.org.uk/guidance/ng49
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis: 2021 update. Journal of Hepatology 2021;75:659–689. https://pubmed.ncbi.nlm.nih.gov/34166721/
- EASL-EASD-EASO. Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology 2024;81:492–542.