Controlled attenuation parameter using the FibroScan® XL probe for quantification of hepatic steatosis for non‐alcoholic fatty liver disease in an Asian population

Abstract

Background: The FibroScan Õ XL probe reduces failure of liver stiffness measurement (LSM) and unreliable results in obese patients. Objective: The objective of this article is to evaluate the accuracy of controlled attenuation parameter (CAP) obtained using the XL probe for the estimation of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Adult NAFLD patients with a liver biopsy within six months were included and were examined with the FibroScan Õ M and XL probes. Histopathological findings were reported according to the Non-Alcoholic Steatohepatitis Clinical Research Network Scoring System. Participants who did not have fatty liver on ultrasonography were recruited as controls. Results: A total of 57 NAFLD patients and 22 controls were included. The mean age of the NAFLD patients and controls was 50.1 AE 10.4 years and 20.2 AE 1.3 years, respectively (p ¼ 0.000). The mean body mass index was 30.2 AE 5.0 kg per m 2 and 20.5 AE 2.4 kg per m 2 , respectively (p ¼ 0.000). The distribution of steatosis grades were: S0, 29%; S1, 17%; S2, 35%; S3, 19%. The AUROC for estimation of steatosis grade ! S1, S2 and S3 was 0.94, 0.80 and 0.69, respectively, using the M probe, and 0.97, 0.81 and 0.67, respectively, using the XL probe. Conclusion: CAP obtained using the XL probe had similar accuracy as the M probe for the estimation of hepatic steatosis in NAFLD patients.

Can the same controlled attenuation parameter cut‐offs be used for M and XL probes for diagnosing hepatic steatosis?

“…9 In a separate study using histology as the reference standard, we found CAP obtained using the XL probe to have similar accuracy as the M probe for the estimation of hepatic steatosis in NAFLD patients. 10 In that study, we observed that CAP obtained using the XL probe tended to be higher compared with the M probe in the overall population as well as for the different grades of hepatic steatosis. Recently, an individual patient data meta-analysis composing of 2735 patients provided optimal cut-offs for CAP obtained using the M probe for the diagnosis of the different grades of hepatic steatosis.…”

“…This is consistent with the observation in our previous study on NAFLD patients. 10 However, the effect appears to be saturated by increasing BMI. This preliminary observation should be corroborated in future studies.…”

Optimal threshold of controlled attenuation parameter with MRI‐PDFF as the gold standard for the detection of hepatic steatosis

“…Fewer studies including small cohorts have assessed the diagnostic accuracy of CAP using XL probe . The sensitivity analyses reveal that CAP measurements were significantly higher using XL probe compared with M probe in the lower grade of hepatic fat content.…”

“…Fewer studies including small cohorts have assessed the diagnostic accuracy of CAP using XL probe. (34,35,44) The sensitivity analyses reveal that CAP measurements were significantly higher using XL probe compared with M probe in the lower grade of hepatic fat content. Similarly, Chan et al (35) have shown significant higher value of CAP using XL probe compared with M probe in an Asian NAFLD cohort.…”

“…The use of the XL probe equipped with CAP has been shown to reduce the failure rate in obese patients providing improvement in the use of CAP for the diagnosis of NAFLD. (34,35) Studies including NAFLD patients have reported different thresholds of CAP using M and XL probe for the grade of steatosis using liver biopsy as reference. (27,36) However, to provide a relevant quantitative threshold of CAP for the detection of hepatic steatosis, measurement using a quantitative modality should be used, and non-NAFLD controls should be included.…”