Impact of skin capsular distance on the performance of controlled attenuation parameter in patients with chronic liver disease

Abstract

Background & AimsControlled attenuation parameter (CAP) is a non‐invasive method for evaluating hepatic steatosis. However, larger skin capsular distance (SCD) can affect the accuracy. The aim of this study was to investigate the impact of SCD on the diagnostic performance of CAP and liver stiffness measurement (LSM).MethodsOf 101 patients with non‐alcoholic fatty liver disease (NAFLD) and 280 patients with chronic hepatitis B (CHB) who underwent liver biopsy were prospectively recruited. CAP, LSM and SCD were performed using FibroScan with M probe. The areas under receiver operating characteristics curves (AUROCs) were calculated to determine the diagnostic efficacy. The optimal thresholds were defined by the maximum Youden index.Results SCD (B 30.34, P < 0.001) and hepatic steatosis (B 23.04, P < 0.001) were independently associated with CAP by multivariate analysis. The AUROCs were slightly higher for SCD <25 mm compared to those for SCD ≥25 mm for steatosis ≥5% (0.88 vs. 0.81), >33% (0.90 vs. 0.85) and >66% (0.84 vs. 0.72). For SCD <25 mm, the optimal CAP cut‐offs for differentiating steatosis ≥5%, >33% and >66% were 255.0 dB/m, 283.5 dB/m and 293.5 dB/m. However, cut‐offs were elevated by approximately 60–70 dB/m for SCD ≥25 mm. When stratified by fibrosis grade, LSM was significantly affected by SCD ≥25 mm for advanced fibrosis (≥F3) in NAFLD, but not in CHB.Conclusion CAP is a promising tool for detecting and quantifying hepatic steatosis. SCD ≥25 mm may cause overestimation of steatosis. Similarly, SCD ≥25 mm affects the detection of advanced fibrosis by LSM in NAFLD patients.

Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values

“…Notably, the first can potentially affect stiffness influencing the architectural structure of the liver, thus changing the propagation time of the vibratory wave through the liver . Similarly, obesity is associated with a higher skin‐to‐liver distance of the hepatic capsula, and the presence of nonhepatic tissue in the volume explored by the M probe might increase stiffness values …”

A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease

“…In comparison, we found backscatter coefficient values to be significantly different in pairwise comparisons of grades 1–3, and the attenuation coefficient was significantly different between all grades except 2 versus 3. Second, the accuracy of the controlled attenuation parameter decreases in obese subjects when compared with nonobese subjects [23], and the technical failure rate associated with obesity can be as high as 33% [26]. In comparison, although most patients included in our QUS study were obese, the technical failure rate was only 1.6% (1/61), suggesting that QUS may be more robust for obese subjects than the controlled attenuation parameter.…”

Correlation of cell-free DNA plasma concentration with severity of non-alcoholic fatty liver disease

“…1). From the initial cohorts, only patients with reliable liver stiffness measurement (LSM) [12], single-proton magnetic resonance spectroscopy ( 1 H-MRS) [13] and elevated hepatic fat content defined by CAP ≥ 248 dB/m [7] were included in final analysis.

Fig. 1Definition of the patient cohort.

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