Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography

Myers, Robert P.; Pollett, Aaron; Kirsch, Richard; Pomier‐Layrargues, Gilles; Beaton, Melanie; Levstik, Mark; Duarte‐Rojo, Andrés; Wong, David T.; Crotty, Pam; Elkashab, Magdy

doi:10.1111/j.1478-3231.2012.02781.x

Cited by 306 publications

(280 citation statements)

References 36 publications

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“…For example, low vitamin D favours intrahepatic lipid accumulation due to increased circulation of free fatty acids (FFA), which is regulated via the J Gastrointestin Liver Dis, June 2016 Vol. 25 No 2: 175-181 peroxisome proliferator-activated receptor gamma (PPAR-γ) [12,13]. Although not all [14,15], many observational studies report associations between vitamin D deficiency and hepatic steatosis [12,16], the aggregate effect of which has been illustrated in a meta-analysis [17] confirming the presence of decreased serum 25-hydroxyvitamin D concentrations in such patients.…”

Section: Introductionmentioning

confidence: 73%

“…We included patients with vitamin D deficiency (serum 25-hydroxyvitamin D < 20 ng/ml) [23] and significant liver fat accumulation, defined as a value ≥ 280 dB/m (as previously reported [24]) using controlled attenuation parameter (CAP) during transient elastography [25]. Exclusion criteria were based on a previously published study in which patients with chronic liver diseases received the same vitamin D supplementation regimen (for full details see [26]).…”

Section: Study Patientsmentioning

confidence: 99%

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Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP)

Papapostoli

Lammert

Stokes

2016

JGLD

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Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. A meta-analysis has confirmed decreased serum 25-hydroxyvitamin D levels in NAFLD patients. This intervention study investigates whether vitamin D correction ameliorates hepatic steatosis. Methods: We prospectively recruited 40 patients from an outpatient liver clinic with vitamin D deficiency (serum 25-hydroxyvitamin D < 20 ng/ml). Controlled attenuation parameter (CAP) during transient elastography quantified hepatic steatosis. Patients with significant liver fat accumulation were included, which was defined by a CAP value ≥ 280 dB/m. Patients received 20,000 IU vitamin D/week for six months, while vitamin D status, liver function tests (LFTs), CAP and body composition were monitored. Results: The cohort comprised 47.5% women (age 54.9 ± 12.1 years; BMI 29.5 ± 3.0 kg/m2). Mean serum vitamin D level was 11.8 ± 4.8 ng/ml. CAP decreased significantly from baseline (330 ± 32 vs. 307 ± 41 dB/m) during supplementation (P = 0.007). A mean CAP reduction relative to baseline was demonstrated at four weeks and three and six months: -5.3 ± 13.8%; -6.0 ± 14.6% and -6.4 ± 13.0%, respectively. During these time points, restoration of serum vitamin D levels was observed (34.6 ± 12.9, 36.3 ± 10.2, 34.8 ± 9.8 ng/ml; P < 0.0001). Liver function tests and body composition remained unchanged. Conclusions: Hepatic steatosis, as assessed by CAP, significantly improves after only 4 weeks of vitamin D correction. Hepatic steatosis is a dynamic process, that can be monitored in the short-term using such non-invasive methods. Abbreviations: ALT: alanine aminotransferase; ANOVA: analysis of variance; AP: alkaline phosphatase; AST: aspartate aminotransferase; CAP: controlled attenuation parameter; CRP: C-reactive protein; FFA: free fatty acids; γ-GT: gamma-glutamyl transpeptidase; ITT: intention-to-treat; LFT: liver function test; LSM: liver stiffness measurement; NAFLD: non-alcoholic fatty liver disease; PPAR-γ: peroxisome proliferator-activated receptor gamma; PP: per protocol; PTH: parathyroid hormone; VDR: vitamin D receptor

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Section: Introductionmentioning

confidence: 73%

Section: Study Patientsmentioning

confidence: 99%

Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP)

Papapostoli

Lammert

Stokes

2016

JGLD

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“…Moreover, CAP accurately detected > 10 and > 33% steatosis with AUROCs of 0.91 and 0.95, respectively [10]. A subsequent larger study of 153 patients with chronic liver disease and body mass index ≥ 28 kg/m 2 found that the optimum cut-off for detecting > 10% steatosis was 283 dB/m giving a sensitivity and specificity of 76 and 79%, respectively [11]. However, CAP had limited ability to differentiate between specific grades of steatosis, particularly between grades 2 and 3 [11].…”

Section: Controlled Attenuation Parametermentioning

confidence: 99%

“…A subsequent larger study of 153 patients with chronic liver disease and body mass index ≥ 28 kg/m 2 found that the optimum cut-off for detecting > 10% steatosis was 283 dB/m giving a sensitivity and specificity of 76 and 79%, respectively [11]. However, CAP had limited ability to differentiate between specific grades of steatosis, particularly between grades 2 and 3 [11]. The largest prospective study assessing CAP in NAFLD included 261 patients and explored the relationship between CAP and steatosis grade (S0 to S3) and also looked at discordance rates and factors associated with discordance [12].…”

Section: Controlled Attenuation Parametermentioning

confidence: 99%

Imaging-Based Assessment of Steatosis, Inflammation and Fibrosis in NAFLD

Hardy

McPherson

2017

Curr Hepatology Rep

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Purpose of Review Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world. Invasive liver biopsy remains the gold standard method for the diagnosis and staging of NAFLD. The aim of this review is to summarize recent research regarding imagingbased assessment of NAFLD. Recent Findings Novel methods such as controlled attenuation parameter (CAP) and magnetic resonance imaging proton-derived fat fraction (MRI-PDFF) appear promising for steatosis assessment and are currently undergoing validation in NAFLD. Fibrosis can be non-invasively assessed by transient elastography (TE), which is currently the best validated test in NAFLD. MR elastography (MRE) appears very sensitive for fibrosis detection. No imaging technique can accurately detect NASH. Summary TE is inexpensive and relatively widely available and can reliably exclude advanced fibrosis in NAFLD. MRI offers the most promise for steatosis and fibrosis quantification, but further validation of these techniques is needed.

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“…hepatorenal index and evaluation of histogram of liver echogenicity differentiate stages of steatosis [4]. Fibroscan (Echosens, France) is widely used in Europe because it includes simultaneous liver stiffness measurement with transient elastography and assessment of steatosis with steatometry and controlled attenuation parameter (CaP) respectively [12]. CaP as a method is presented by correlation of stage of attenuation in liver parenchyma in dB/m with the stage of steatosis according to the morphological scale saF/Nas [14].…”

mentioning

confidence: 99%

Evaluation of multiparametric echography in diagnosis of nonalcoholic fatty liver disease in type 2 diabetes mellitus

Марунчин

Bodnar

Динник

et al. 2017

CE&ES

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Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography

Abstract: The CAP is a promising tool for the noninvasive detection of hepatic steatosis. Advantages of CAP include its ease of measurement, operator-independence and simultaneous availability with LSM for fibrosis assessment.

Cited by 306 publications

References 36 publications

Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP)

Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP)

Imaging-Based Assessment of Steatosis, Inflammation and Fibrosis in NAFLD

Evaluation of multiparametric echography in diagnosis of nonalcoholic fatty liver disease in type 2 diabetes mellitus

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