Controlled attenuation parameter for non‐invasive assessment of hepatic steatosis: Does etiology affect performance?

Kumar, Manoj; Rastogi, Archana; Singh, Tarandeep; Behari, Chhagan; Gupta, Ekta; Garg, Hitendra; Kumar, Ramesh; Bhatia, Vikram; Sarin, Shiv Kumar

doi:10.1111/jgh.12134

Cited by 94 publications

(91 citation statements)

References 30 publications

(71 reference statements)

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“…with areas under the ROC curves of 0.84, 0.86 and 0.93 for >10 % (S1), >33 % (S2) and >67 % (S3) steatosis respectively [88] or with areas under the ROC curves of 0.79, 0.76 and 0.70 for >5 %, >33 % and >67 % steatosis respectively [89]. There is evidence that the aetiology of steatosis does not affect the accuracy of CAP™ [90]. …”

Section: Ultrasound Modalitiesmentioning

confidence: 99%

Ultrasound in chronic liver disease

2014

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BackgroundWith the high prevalence of diffuse liver disease there is a strong clinical need for noninvasive detection and grading of fibrosis and steatosis as well as detection of complications.MethodsB-mode ultrasound supplemented by portal system Doppler and contrast-enhanced ultrasound are the principal techniques in the assessment of liver parenchyma and portal venous hypertension and in hepatocellular carcinoma surveillance.ResultsFibrosis can be detected and staged with reasonable accuracy using Transient Elastography and Acoustic Radiation Force Imaging. Newer elastography techniques are emerging that are undergoing validation and may further improve accuracy. Ultrasound grading of hepatic steatosis currently is predominantly qualitative.ConclusionA summary of methods including B-mode, Doppler, contrast-enhanced ultrasound and various elastography techniques, and their current performance in assessing the liver, is provided.Teaching Points• Diffuse liver disease is becoming more prevalent and there is a strong clinical need for noninvasive detection.• Portal hypertension can be best diagnosed by demonstrating portosystemic collateral venous flow.• B-mode US is the principal US technique supplemented by portal system Doppler.• B-mode US is relied upon in HCC surveillance, and CEUS is useful in the evaluation of possible HCC.• Fibrosis can be detected and staged with reasonable accuracy using TE and ARFI.• US detection of steatosis is currently reasonably accurate but grading of severity is of limited accuracy.

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Section: Ultrasound Modalitiesmentioning

confidence: 99%

Ultrasound in chronic liver disease

2014

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“…A measurement method is precise if it gives values that are both accurate and reproducible. Several studies have investigated the diagnostic accuracy of CAP in the quantification of liver steatosis by comparing the results to liver histology [4,[6][7][8][9][10][11]. Data on the reproducibility of CAP measurements are few.…”

Section: Introductionmentioning

confidence: 98%

Interobserver reproducibility of the controlled attenuation parameter (CAP) for quantifying liver steatosis

et al. 2014

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“…Some recent studies have shown that CAP significantly correlates with the grade of steatosis in patients with CLD of different etiologies [22][23][24] . However, the accuracy of CAP for quantifying steatosis in patients with CLD varies among studies.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Controlled Attenuation Parameter for Detecting Hepatic Steatosis in Patients with Chronic Liver Disease

Andrade

Rodrigues

Rodrigues‐Pinto

et al. 2016

GE Port J Gastroenterol

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Introduction: Controlled attenuation parameter (CAP), measured by transient elastography, has been suggested as a noninvasive method for the detection and quantification of steatosis. We aimed to assess the accuracy of CAP to detect steatosis in patients with chronic liver disease (CLD) compared with liver histology and to evaluate factors that correlate with the CAP value. Methods: Patients with CLD who underwent liver biopsy and simultaneous CAP determination were consecutively enrolled. CAP was measured using the M probe of FibroScan® (Echosens, Paris, France). Histologically, steatosis was categorized as absent (S0: <5%), mild (S1: 5-33%), moderate (S2: 34-66%) and severe (S3: >66% of all hepatocytes). Results: We analyzed 159 patients with CLD (61% men, mean age 47.9 ± 12.9 years). We found a positive correlation between CAP and steatosis in histology (r_s = 0.869, p < 0.001), arterial hypertension (r_s = 0.222, p = 0.005), type 2 diabetes mellitus (r_s = 0.279, p < 0.001), body mass index (BMI; r_s = 0.533, p < 0.001), total cholesterol (r_s = 0.442, p < 0.001), triglycerides (r_s = 0.272, p = 0.001), and non-alcoholic fatty liver disease (NAFLD; r_s = 0.588, p < 0.001). In the multivariate analysis, BMI >25 (odds ratio [OR] 48.4, 95% confidence interval [CI] 23.78-72.95, p < 0.001), serum total cholesterol (OR 3.803, 95% CI 2.203-13.889, p = 0.008), and NAFLD etiology (OR 40.8, 95% CI 15.01-66.66, p = 0.002) were independently associated with higher CAP values. We did not find any significant correlation between CAP and the grade of necroinflammatory activity (r_s = 0.063, p = 0.808) or fibrosis (r_s = 0.071, p = 0.713) in histology and with alanine aminotransferase (r_s = 0.190, p = 0.356) or aspartate aminotransferase (r_s = 0.117, p = 0.142). Optimal CAP cutoff values for detecting steatosis ≥S1, ≥S2, and ≥S3 were 206.5, 232.5, and 282.5 dB/m, respectively. CAP performance was 0.822, 0.956, and 0.976 for diagnosing steatosis ≥S1, ≥S2, and ≥S3, respectively. Conclusions: CAP had an excellent diagnostic accuracy for the detection of steatosis in diverse CLD patients. A CAP value cutoff of <282.5 dB/m excludes severe steatosis ≥S3 with an accuracy of 98%.

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Controlled attenuation parameter for non‐invasive assessment of hepatic steatosis: Does etiology affect performance?

Abstract: CAP is a novel, non-invasive tool that can detect and quantify steatosis accurately among CHBV, CHCV, and NAFLD patients, the accuracy being similar for all the three groups of patients.

Cited by 94 publications

References 30 publications

Ultrasound in chronic liver disease

Ultrasound in chronic liver disease

Interobserver reproducibility of the controlled attenuation parameter (CAP) for quantifying liver steatosis

Diagnostic Accuracy of Controlled Attenuation Parameter for Detecting Hepatic Steatosis in Patients with Chronic Liver Disease

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