Novel reliability criteria for controlled attenuation parameter assessments for non‐invasive evaluation of hepatic steatosis

Abstract

Background There is conflicting evidence regarding reliability criteria for the controlled attenuation parameter (CAP; a marker for hepatic steatosis [HS]). Thus, we assessed the diagnostic performance of CAP according to different reliability criteria based on real-world data from an academic centre. Methods Patients undergoing measurement of CAP and liver biopsy (±6 months) at the Medical University of Vienna were included. HS was assessed according to SAF score. Results In total 319 patients were included. The main aetiologies were non-alcoholic fatty liver disease (NAFLD, n = 177, 55.5%), viral hepatitis ( n = 49, 15.4%), and alcoholic liver disease (ALD, n = 29, 9.1%). Histological steatosis and fibrosis stages were: S0: 93 (29.2%), S1: 100 (31.3%), S2: 67 (21.0%), and S3: 59 (18.5%); F0/F1: 150 (47.0%), F2: 47 (14.7%), and F3/F4: 122 (48.3%). In the overall cohort, the area under the receiver operating characteristic curve (AUC) of CAP was 0.843 (95% confidence interval [CI]: 0.798–0.887) for diagnosing HS ≥ S1), 0.789 (95%CI: 0.740–0.839) for ≥S2, and 0.767 (95%CI: 0.712–0.823) for S3. CAP corrections as suggested by Karlas et al. did not improve the diagnostic performance. Importantly, the AUC of CAP for HS ≥ S1 was numerically highest in patients with CAP-IQR/median<0.10 or <0.20 (obtained in 37.9% and 74.9%), in whom CAP also had better diagnostic performance, as compared with patients not meeting these criteria. Moreover, it was substantially higher in 288 (90.3%) patients with CAP-IQR/median<0.3: 0.856 (95%CI: 0.809–0.903) vs. patients not meeting this criterion (0.530 [95%CI: 0.309–0.751]). In contrast, the previously suggested reliability criterion of CAP-IQR<40 dB/m was not associated with an improved diagnostic performance for HS≥S1 (0.866 [95%CI: 0.812–0.920] vs. 0.799 [95%CI: 0.717–0.881]) and was only obtained in 199 (62.4%) patients. Conclusion CAP-IQR/median<0.1, <0.2, and <0.3 identify reliable measurements for diagnosing any hepatic steatosis (≥S1). Importantly, CAP-IQR/median<0.3 has a considerably higher applicability in clinical practice, as compared with the previously suggested CAP-IQR<40 dB/m criterion.

PNPLA3 and SERPINA1 Variants Are Associated with Severity of Fatty Liver Disease at First Referral to a Tertiary Center

“…The measurements were carried out after patients fasted for a period of at least 3 h. The M- and XL-probes were chosen as suggested by the manufacturer or based on the expertise of the hepatologist. Patients were instructed to lie in a dorsal position with the right arm in abduction, and measurements were performed on the right lobe of the liver through the intercostal spaces [ 17 ]. The reliability of LSM was defined in accordance with previously established criteria [ 18 ].…”

Comparison between magnetic resonance and ultrasound-derived indicators of hepatic steatosis in a pooled NAFLD cohort

“…For example, the minimum and maximum of all the optimal MRI PDFF thresholds reported in the cited studies to identify steatosis grades � 1, � 2 and �3 were [min max] = [3.7% 12.5%], [11.3% 17.4%], and [16.7% 26.5%] respectively [16][17][18][19]21,41,42]. The minimum and maximum of all the CAP thresholds reported in the cited studies to identify steatosis grades � 1, � 2 and �3 were [min max] = 236 dB/m 331 dB/m], [256 dB/m 361dB/m], and [283 dB/m 344 dB/m] respectively [29][30][31][32][33][34][35]41,42]. Further studies are required to validate the applicability of specific optimal thresholds for identifying different steatosis grades.…”

“…The measurement is performed using the ultrasound-based technology FibroScan 1 [Echosens, Paris, France] [28]. Although CAP has been shown to work well for the detection of significant hepatic steatosis, results from different studies suggest discordance between CAP and histology scores, and in particular, the diagnostic accuracy is impaired by an increased BMI as well as presence of NASH, NAFLD, and Type 2 diabetes [29][30][31][32][33][34][35][36].…”

Controlled Attenuation Parameter for Quantification of Steatosis: Which Cut-Offs to Use?

“…Another study has set the IQR upper limit at 30 dB/m [ 8 ], while another study found no difference in CAP performance when the IQR was ≥30 dB/m or ≥40 dB/m [ 20 ]. A recently published study demonstrated that CAP-IQR/M < 0.3 as a quality criterion improves accuracy and feasibility of CAP measurements, performing better than the IQR < 40 dB/m criterion [ 21 ].…”