The clinical value of controlled attenuation parameter for the noninvasive assessment of liver steatosis

Ferraioli, Giovanna; Tinelli, Carmine; Silvestri, Annalisa De; Lissandrin, Raffaella; Above, Elisabetta; Dellafiore, Carolina; Poma, Gianluigi; Gregorio, Marta Di; Maiocchi, Laura; Maserati, Renato; Fı̀lice, Carlo

doi:10.1111/liv.13207

Cited by 22 publications

(16 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study confirmed the diagnostic value of the CAP for the detection of steatosis compared with US as a reference method in the general population as previous studies have demonstrated in patients with chronic liver diseases [24]. Recently, an Italian study compared the use of CAP and US in a cohort predominantly affected by chronic viral hepatitis [25]. This study demonstrated that, in patients with chronic viral hepatitis, CAP was superior to US in detecting hepatic steatosis, whereas in patients with nonsignificant liver disease, US performed better than CAP.…”

Section: Introductionsupporting

confidence: 86%

Potential impact of screening for fatty liver disease by transient elastography with liver stiffness and controlled attenuation parameter measurements: a pilot study

Peiseler¹,

Creutzfeldt²,

Cassens³

et al. 2017

Z Gastroenterol

View full text Add to dashboard Cite

The prevalence of chronic liver diseases is high in developed countries, and the leading causes are amenable to prevention. The German Lebertag is to increase awareness of the burden of chronic liver diseases in the general public. We performed a pilot study using transient elastography with liver stiffness measurement (LSM) and the controlled attenuation parameter (CAP) as a screening tool for previously unrecognized liver diseases. LSM and CAP was performed in 60 individuals, and participants filled in a questionnaire reporting basic characteristics and past medical history. Median LSM and CAP values were within the normal range. Participants with self-reported diabetes mellitus had significantly elevated LSM (p = 0.02) and CAP values (p = 0.002). Participants with a BMI > 30 kg/m or dyslipidemia had significantly elevated CAP values (p = 0.007 and p = 0.01, respectively) with normal LSM values. Overall, 35 % of participants had elevated CAP values, indicating a high prevalence of hepatic steatosis. In a German pilot study, diabetes mellitus was a key risk factor for increased LSM and CAP values. Prevalence of steatosis was high and comparable to other Western countries. Transient elastography is a valuable tool to identify patients with increased risk for metabolic liver diseases. In people without risk factors, LSM and CAP values were within the normal range, indicating that screening for chronic liver injury was not warranted.

show abstract

Section: Introductionsupporting

confidence: 86%

Potential impact of screening for fatty liver disease by transient elastography with liver stiffness and controlled attenuation parameter measurements: a pilot study

Peiseler¹,

Creutzfeldt²,

Cassens³

et al. 2017

Z Gastroenterol

View full text Add to dashboard Cite

show abstract

“…Therefore we fitted two-level Bayesian latent class models with discrete latent variables to estimate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnostic tests (imperfect gold standard methodology), as previously reported [14]. Briefly, the observed results of the diagnostic tests are considered as a measure, prone to error, of an unobservable (latent) dichotomous variable, i.e.…”

Section: Methodsmentioning

confidence: 99%

Noninvasive assessment of liver steatosis in children: the clinical value of controlled attenuation parameter

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundTo assess the clinical validity of controlled attenuation parameter (CAP) in the diagnosis of hepatic steatosis in a series of overweight or obese children by using the imperfect gold standard methodology.MethodsConsecutive children referred to our institution for auxological evaluation or obesity or minor elective surgery were prospectively enrolled. Anthropometric and biochemical parameters were recorded. Ultrasound (US) assessment of steatosis was carried out using ultrasound systems. CAP was obtained with the FibroScan 502 Touch device (Echosens, Paris, France). Pearson’s or Spearman’s rank correlation coefficient were used to test the association between two study variables. Optimal cutoff of CAP for detecting steatosis was 249 dB/m. The diagnostic performance of dichotomized CAP, US, body mass indexes (BMI), fatty liver index (FLI) and hepatic steatosis index (HSI) was analyzed using the imperfect gold standard methodology.ResultsThree hundred five pediatric patients were enrolled. The data of both US and CAP were available for 289 children. Steatosis was detected in 50/289 (17.3%) children by US and in 77/289 (26.6%) by CAP. A moderate to good correlation was detected between CAP and BMI (r = 0.53), FLI (r = 0.55) and HSI (r = 0.56). In obese children a moderate to good correlation between CAP and insulin levels (r = 0.54) and HOMA-IR (r = 0.54) was also found. Dichotomized CAP showed a performance of 0.70 (sensitivity, 0.72 [0.64–0.79]; specificity, 0.98 [0.97–0.98], which was better than that of US (performance, 0.37; sensitivity, 0.46 [0.42–0.50]; specificity, 0.91 [0.89–0.92]), BMI (performance, 0.22; sensitivity, 0.75 [0.73–0.77]; specificity, 0.57 [0.55–0.60]) and FLI or HSI.ConclusionsFor the evaluation of liver steatosis in children CAP performs better than US, which is the most widely used imaging technique for screening patients with a suspicion of liver steatosis. A cutoff value of CAP of 249 dB/m rules in liver steatosis with a very high specificity.

show abstract

“…Abdominal gas or obesity may decrease the applicability of B-mode US. Moreover, in patients with liver fibrosis the accuracy of the technique for diagnosing hepatic steatosis may decrease[8,9]. On the other hand, a significant intra- and inter-observer variability for the assessment of the US findings of liver steatosis has been reported[10,11].…”

Section: Ultrasound: Semiquantitative Assessmentmentioning

confidence: 99%

Ultrasound-based techniques for the diagnosis of liver steatosis

Ferraioli

Monteiro

2019

WJG

Self Cite

292

220

View full text Add to dashboard Cite

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of diffuse liver disease. An accurate estimate of the fat in the liver is important in the diagnostic work-up of patients with NAFLD because the degree of liver steatosis is linked to the metabolic syndrome and the cardiovascular risk. Ultrasound (US) B-mode imaging allows to subjectively estimate the fatty infiltration in the liver; however, it has a low performance for the detection of mild steatosis. Quantitative US is based on the analysis of the radiofrequency echoes detected by an US system, and it allows to calculate a backscatter coefficient or an attenuation coefficient or the sound speed. The estimation of the backscatter coefficient is rather cumbersome and requires the use of a phantom for addressing all sources of variability. Controlled attenuation parameter (CAP) available on the FibroScan® system (Echosens, France) measures the attenuation of the US beam. CAP is accurate in grading fatty infiltration-even though there is an overlap between consecutive grade of liver steatosis-and the values are not influenced by liver fibrosis. Several US manufacturers are developing or have already developed software for quantifying the attenuation of the US beam. Preliminary results show that proprietary technologies implemented in US systems seem more accurate than CAP for grading liver steatosis. Another available method for quantifying liver steatosis is based on the computation of the sound speed and the initial results appear promising.

show abstract

The clinical value of controlled attenuation parameter for the noninvasive assessment of liver steatosis

Abstract: In patients with chronic viral hepatitis and advanced liver fibrosis, controlled attenuation parameter performs better than ultrasound for assessing liver steatosis, whereas in patients without viral hepatitis and with nonsignificant liver disease ultrasound shows the best performance.

Cited by 22 publications

References 31 publications

Potential impact of screening for fatty liver disease by transient elastography with liver stiffness and controlled attenuation parameter measurements: a pilot study

Potential impact of screening for fatty liver disease by transient elastography with liver stiffness and controlled attenuation parameter measurements: a pilot study

Noninvasive assessment of liver steatosis in children: the clinical value of controlled attenuation parameter

Ultrasound-based techniques for the diagnosis of liver steatosis

Contact Info

Product

Resources

About