Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis

Cao, Yu-tian; Xiang, Liu-lan; Qi, Fang; Zhang, Yujuan; Chen, Yi; Zhou, Xiqiao

doi:10.1016/j.eclinm.2022.101547

Cited by 55 publications

(43 citation statements)

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“…Therefore, the true prevalence of undiagnosed fatty liver may have been underestimated due to the lack of sensitivity of ultrasound for distinguishing mild steatosis. When using the CAP, the pooled sensitivity of detecting mild steatosis could be as high as 84% according to a recently published meta-analysis of 61 studies and 10537 included patients [11]. In the present study, 38.0% of the rural cases were identi ed as MAFLD, which is almost two times that reported in a previous study.…”

Section: Discussionsupporting

confidence: 46%

“…The M probe was used initially unless the machine indicated the use of the XL probe [10]. Cutoff values applied for CAP and liver stiffness across different grades of steatosis and brosis were derived from a recent meta-analysis as described below [11]: S0 to S3 was de ned as < 244 dB/m 244-264 dB/m; 265-291 dB/m);>292 dB/m, while F0-F1, F2, F3 and F4 was classi ed as < than 8.2kPa, 8.2-9.6 kPa, 9.7-13.5 and > 13.5kPa. CAP of 244 dB/m or greater (≥ S1) were considered as fatty liver and liver stiffness of 9.7 kPa or greater(≥ F3) were considered as advanced brosis.…”

Section: Cap Measurement and Liver Stiffness Measurementmentioning

confidence: 99%

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Rural-urban disparities in epidemiology of metabolic associated fatty liver disease in the representative area of China

et al. 2022

Preprint

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Background The unexpectedly increased burden of metabolic associated fatty liver disease (MAFLD) continues in China, and the differences between rural and urban areas remain unclear. We aimed to clarify the prevalence and risk factors in rural areas of China. Methods This cross-sectional study used the most densely populated area with highly unbalanced development differences in China (Guangdong Province) as a representative sample, and multistage stratified random sampling was performed. The participants’ demographic, socioeconomic, and lifestyle data were collected. Fatty liver and liver stiffness were screened by FibroScan. Results A total of 7287 individuals were enrolled (rural: 2684; urban: 4603). The overall MAFLD prevalence was 35.7%, and MAFLD was higher among rural individuals (38.0% vs. 34.4%, p < 0.001) than urban individuals. Rural individuals had more severe hepatic fibrosis (fibrosis stage 3–4) overall (3.0% vs. 1.3%) and among different sexes (male: 4.2% vs. 2.0%; female: 1.5% vs. 0.5%) (all p < 0.05) than urban individuals. For both rural and urban individuals, lifestyle and dietary habits, including midnight snacks, dining out, and overeating salt, red meat and sugar, were associated with an increased risk of MAFLD, and drinking tea and consuming dietary fibers were associated with a decreased risk of MAFLD. However, midnight snacks and overeating red meat were associated with a higher risk of hepatic fibrosis only in urban individuals. Conclusion There is a surprisingly high burden of MAFLD in rural Guangdong, China, which implicates a lack of awareness among rural individuals and a warrant the need for disease counteraction strategies.

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Section: Discussionsupporting

confidence: 46%

Section: Cap Measurement and Liver Stiffness Measurementmentioning

confidence: 99%

Rural-urban disparities in epidemiology of metabolic associated fatty liver disease in the representative area of China

et al. 2022

Preprint

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“…There are various reference values of CAP and LSM for assessing hepatic steatosis and fibrosis from previous studies. It means that the cut-off values could vary from many factors such as countries, ethnics, statistical methods, underlying clinical characteristics and so on [ 40 – 42 ]. Further large-scale, prospective studies are required to confirm our results and the effect of managing hepatic steatosis in reducing colorectal tumorigenesis.…”

Section: Discussionmentioning

confidence: 99%

Association between severe hepatic steatosis examined by Fibroscan and the risk of high-risk colorectal neoplasia

et al. 2022

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The prevalence of colorectal neoplasm in patients with non-alcoholic fatty liver disease has increased twice as high as that in the general population. FibroScan is a new modality for evaluating hepatic steatosis. This study aimed to investigate the relationship between the risk of high-risk colorectal neoplasia and hepatic steatosis examined using FibroScan. This was a cross sectional study of prospectively enrolled subjects who were scheduled to undergo index colonoscopy as a health screening between March 2018 and February 2019. The severity of steatosis was graded as normal, mild, moderate, or severe using FibroScan. A total of 140 consecutive subjects were enrolled and sequentially examined using FibroScan and colonoscopy. Subjects with hepatic steatosis had more high-risk colorectal neoplasia than those without hepatic steatosis. In addition, tumor size was larger in subjects with hepatic steatosis. In multivariable analysis, severe hepatic steatosis was an independent risk factor for high-risk colorectal neoplasia (adjusted odds ratio: 3.309, confidence interval: 1.043–10.498, p = 0.042). Alcohol consumption was also identified as a risk factor for high-risk colorectal neoplasia. In conclusion, severe hepatic steatosis on FibroScan is associated with the development of high-risk colorectal neoplasia. Thus, physicians should be aware of the association between colorectal neoplasia and hepatic steatosis assessed by FibroScan and its clinical implications.

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“…The FibroScan enables simultaneous LS and LF estimation during the same clinical session [ 10 ]. CAP is also recommended as the method of choice for the NAFLD/MAFLD patients for whom a liver biopsy will be necessary for diagnostics, as it is suitable for reliable non-invasive S ≥ S1 and advanced-stage liver fibrosis (F ≥ 3) evaluation [ 36 ]. This is particularly important in light of possible liver biopsy complications and costs and also in light of the poorer CAP performance in the S2 and S3 areas, especially in obese patients [ 7 , 10 , 36 ].…”

Section: Possible Clinical Applicability Of Qnusmentioning

confidence: 99%

“…CAP is also recommended as the method of choice for the NAFLD/MAFLD patients for whom a liver biopsy will be necessary for diagnostics, as it is suitable for reliable non-invasive S ≥ S1 and advanced-stage liver fibrosis (F ≥ 3) evaluation [ 36 ]. This is particularly important in light of possible liver biopsy complications and costs and also in light of the poorer CAP performance in the S2 and S3 areas, especially in obese patients [ 7 , 10 , 36 ]. This method could also be useful for LS monitoring in patients with concurrent NAFLD and AFLD, including those with elevated BMI and DM2, where the risk of disease complications and disease-related mortality is particularly high [ 10 , 37 ].…”

Section: Possible Clinical Applicability Of Qnusmentioning

confidence: 99%

Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area

Hari

2022

Diagnostics

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Liver steatosis is a chronic liver disease that is becoming one of the most important global health problems, due to its direct connection with metabolic syndrome, its significant impact on patients’ socioeconomic status and frailty, and the occurrence of advanced chronic liver disease. In recent years, there has been rapid technological progress in the ultrasound-based diagnostics field that can help us to quantitatively assess liver steatosis, including continuous attenuation parameters in A and B ultrasound modes, backscatter coefficients (e.g., speed of sound) and ultrasound envelope statistic parametric imaging. The methods used in this field are widely available, have favorable time and financial profiles, and are well accepted by patients. Less is known about their reliability in defining the presence and degree of liver steatosis. Numerous study reports have shown the methods’ favorable negative and positive predictive values in comparison with reference investigations (liver biopsy and MRI). Important research has also evaluated the role of these methods in diagnosing and monitoring non-alcoholic fatty liver disease (NAFLD). Since NAFLD is becoming the dominant global cause of liver cirrhosis, and due to the close but complex interplay of liver steatosis with the coexistence of liver fibrosis, knowledge regarding NAFLD’s influence on the progression of liver fibrosis is of crucial importance. Study findings, therefore, indicate the possibility of using these same diagnostic methods to evaluate the impact of NAFLD on the patient’s liver fibrosis progression risk, metabolic risk factors, cardiovascular complications, and the occurrence of hepatocellular carcinoma. The mentioned areas are particularly important in light of the fact that most of the known chronic liver disease etiologies are increasingly intertwined with the simultaneous presence of NAFLD.

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Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis

Cited by 55 publications

References 100 publications

Rural-urban disparities in epidemiology of metabolic associated fatty liver disease in the representative area of China

Rural-urban disparities in epidemiology of metabolic associated fatty liver disease in the representative area of China

Association between severe hepatic steatosis examined by Fibroscan and the risk of high-risk colorectal neoplasia

Ultrasound-Based Diagnostic Methods: Possible Use in Fatty Liver Disease Area

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