title: Controlled attenuation parameter for the diagnosis of steatosis in non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  Controlled attenuation parameter (CAP) evaluated with transient elastography (FibroScan) is a recent method for non-invasive assessment of steatosis. Its usefulness in non-alcoholic fatty liver disease (NAFLD) is unknown. We prospectively investigated the performance of CAP for the diagnosis of steatosis in NAFLD, factors associated with discordances between CAP and steatosis grades, and relationships between CAP and clinical or biological parameters.
  
  
  METHODS
  All CAP examinations performed in NAFLD patients with a liver biopsy performed within 1 week of CAP measurement were included. Liver biopsies were assessed for activity and fibrosis stage, NAFLD activity score, and steatosis graded as follows: S0, steatosis < 5%; S1, 5-33%; S2, 34-66%; S3, >66%.
  
  
  RESULTS
  Two hundred sixty-one patients (59% male, age 56 years) from two ethnic groups were included. No patient had steatosis < 5%. The area under the receiver-operating characteristics curve of CAP for steatosis ≥S2 and S3 was 0.80 and 0.66, respectively. At a cut-off value of 310 dB/m, the sensitivity, specificity, and positive and negative predictive values for ≥S2 steatosis were 79%, 71%, 86%, and 71%, respectively. Discordance of at least one grade between CAP and steatosis was observed in 81 patients. By multivariate analysis, only steatosis S2S3 was associated with no discordance. By multivariate analysis, only BMI ≥ 30 kg/m(2) was significantly associated with CAP > 310 dB/m.
  
  
  CONCLUSIONS
  The association of CAP with steatosis, especially in patients with non-alcoholic steatohepatitis, and with elevated BMI could be useful for the diagnosis and follow-up of NAFLD patients.
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.|INSERM U1053, Bordeaux University, Bordeaux, France.
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.affiliation: State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.affiliation: State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Hiriart
authors.affiliation: Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Anthony Wing-Hung
authors.initials: AW
authors.lastname: Chan
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
authors.forename: Faiza
authors.initials: F
authors.lastname: Chermak
authors.affiliation: Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Paul Cheung-Lung
authors.initials: PC
authors.lastname: Choi
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.|INSERM U1053, Bordeaux University, Bordeaux, France.
authors.forename: Carmen Ka-Man
authors.initials: CK
authors.lastname: Chan
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.
authors.forename: Wassil
authors.initials: W
authors.lastname: Merrouche
authors.affiliation: Investigation Center of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France.|INSERM U1053, Bordeaux University, Bordeaux, France.
authors.forename: Angel Mei-Ling
authors.initials: AM
authors.lastname: Chim
authors.affiliation: INSERM U1053, Bordeaux University, Bordeaux, France.|Department of Pathology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Le Bail
authors.affiliation: State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: CAP; FibroScan; NAFLD; liver stiffness; metabolic syndrome; obesity; steatosis; transient elastography