Liver Steatosis Assessed by Controlled Attenuation Parameter (CAP) Measured with the XL Probe of the FibroScan: A Pilot Study Assessing Diagnostic Accuracy

Sasso, M.; Audière, Stéphane; Kemgang, Astrid; Gaouar, Farid; Corpechot, Christophe; Chazouillères, Olivier; Fournier, C.; Golsztejn, Olivier; Prince, Stéphane; Menu, Y.; Sandrin, Laurent; Miette, Véronique

doi:10.1016/j.ultrasmedbio.2015.08.008

Cited by 131 publications

(96 citation statements)

References 40 publications

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“…There was no significant correlation between CAP and MRS in the HCV-monoinfected group, likely due to the very small sample size in this subgroup. Our finding that CAP-MRS was able to detect ≥mild HS with an area under the ROC of 0.85 in the whole cohort and 0.88 in the HIV-monoinfected group is also consistent with published literature, with area under the ROC for detection of ≥mild HS ranging from 0.80–0.88 using histology as the reference standard(27, 30–32) and 0.83–0.90 using MRS as the reference standard(33). …”

Section: Discussionsupporting

confidence: 90%

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

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Dodge

Ma³

et al. 2017

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Objective Hepatic steatosis (HS) is common in HIV-infected individuals. Magnetic resonance spectroscopy (MRS) is the preferred non-invasive method for HS measurement but is expensive. Controlled attenuation parameter (CAP) also assesses HS and is conveniently performed concomitantly with transient elastography. We aimed to assess the accuracy of CAP in the setting of HIV infection. Design Cross-sectional study Methods CAP and MRS were performed in 82 subjects (39 HIV-monoinfected;7 HCV-monoinfected;21 HIV/HCV-coinfected; 15 with neither infection). We used concordance correlation coefficients to compare log-transformed and standardized CAP and MRS values and linear regression to examine factors associated with CAP and MRS-measured HS. The accuracy of CAP to detect ≥mild HS, defined as MRS-liver fat fraction ≥0.05, and the factors associated with discordance between CAP and MRS were evaluated. Results Overall, CAP-HS and MRS-HS correlated moderately well (r=0.60, p<0.001), and correlation was strongest in the HIV-monoinfected group (r=0.67, p<0.001). Body composition factors (higher BMI, waist circumference, visceral and abdominal subcutaneous adipose tissue) and insulin resistance were significantly associated with both greater CAP-HS and MRS-HS. Using a validated CAP cut-off ≥238 decibels/meter, sensitivity and specificity for ≥mild HS were 84% and 75% in the entire cohort; 89% and 80% in the HIV-monoinfected group. Higher body composition parameters were more likely to be misclassified as having HS by CAP. Conclusions Our findings suggest CAP is an acceptable non-invasive surrogate for HS in HIV-infected individuals but may overestimate HS prevalence, especially in individuals with high BMI. Evaluation of factors that improve CAP accuracy and determination of optimal cut-offs are warranted.

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Section: Discussionsupporting

confidence: 90%

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

Price¹,

Dodge

Ma³

et al. 2017

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“…The high failure rate in patients with NAFLD is not surprising as until recently CAP was only available on the FibroScan™ M probe. The development of CAP on the XL probe may overcome these limitations [16,17], but further validation is needed.…”

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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“…Of these, CAP is the most validated and commercially available through Echosens (Paris, France), the manufacturer of FibroScan ® . CAP is an objective measure of ultrasound attenuation and can be performed using the appropriately selected FibroScan probe to measure liver stiffness and steatosis simultaneously [18, 19]. A preliminary study in a mixed population of diffuse liver disease reported high correlation of CAP with histological steatosis grade (correlation coefficient 0.81) with excellent severity grading performance and high reproducibility [20].…”

Section: Conventional Imagingmentioning

confidence: 99%

“…A preliminary study in a mixed population of diffuse liver disease reported high correlation of CAP with histological steatosis grade (correlation coefficient 0.81) with excellent severity grading performance and high reproducibility [20]. In a NAFLD population, validation data are still incomplete, but CAP has thus far shown promise as a standardized quantitative US biomarker for steatosis [19, 21]. However, further validation is needed, including evaluation of newer probes optimized for obese patients.…”

Section: Conventional Imagingmentioning

confidence: 99%

Quantitative Imaging Biomarkers of NAFLD

2016

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Conventional imaging modalities, including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR), play an important role in the diagnosis and management of patients with nonalcoholic fatty liver disease (NAFLD) by allowing noninvasive diagnosis of hepatic steatosis. However, conventional imaging modalities are limited as biomarkers of NAFLD for various reasons. Multi-parametric quantitative MRI techniques overcome many of the shortcomings of conventional imaging and allow comprehensive and objective evaluation of NAFLD. MRI can provide unconfounded biomarkers of hepatic fat, iron, and fibrosis in a single examination—a virtual biopsy has become a clinical reality. In this article, we will review the utility and limitation of conventional US, CT, and MR imaging for the diagnosis NAFLD. Recent advances in imaging biomarkers of NAFLD are also discussed with an emphasis in multi-parametric quantitative MRI.

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Liver Steatosis Assessed by Controlled Attenuation Parameter (CAP) Measured with the XL Probe of the FibroScan: A Pilot Study Assessing Diagnostic Accuracy

Cited by 131 publications

References 40 publications

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults

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

Quantitative Imaging Biomarkers of NAFLD

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