title: Impact of anthropometric features on the applicability and accuracy of FibroScan®(M and XL) in overweight/obese patients.
abstract: OBJECTIVE
  Transient elastography is the reference method for liver stiffness measurement (LSM) in the general population, having lower applicability in obese patients. We evaluated the applicability and diagnostic accuracy of the M and XL probes in overweight/obese patients to establish the most appropriate approach.
  
  
  METHODS
  From May 2013 to March 2015, we evaluated patients with a body mass index (BMI) ≥ 28 kg/m2. We constructed an algorithm with variables independently related to unreliable LSM with the M probe.
  
  
  RESULTS
  A total of 1084 patients were evaluated. M and XL probe applicability was 88.8% and 98%, respectively. Waist circumference (WC) (OR; 95% CI; P) (0.97; 0.94-0.99; P < 0.001) and skin-capsule distance (SCD) (0.83; 0.79-0.87; P < 0.001) were independently related to unreliable LSM (M probe). The SCD was > 25 mm in 5.5% of individuals with a BMI ≤ 35 kg/m2and a WC ≤ 117 cm, with LSM (M probe) applicability rising to 94.3%. In contrast, 36.9% of patients with a BMI > 35 kg/m2and/or a WC > 117 cm presented an SCD > 25 mm, with M probe applicability being 73.1%. The diagnostic accuracy (area under the receiver operator characteristic) using the M probe to identify significant steatosis (0.76), fibrosis (0.89), and cirrhosis (0.96) was very high in patients with a BMI ≤ 35 kg/m2and a WC ≤ 117 cm.
  
  
  CONCLUSIONS
  The applicability and accuracy of the FibroScan®M probe to identify fibrosis and steatosis was excellent in overweight and obesity grade I (BMI ≤ 35 kg/m2) with a WC ≤ 117 cm. The XL probe increased the applicability of transient elastography in obesity grade II-III (BMI > 35 kg/m2).
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Puigvehí
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Broquetas
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Department of Medicine, Universitat Autonoma, Barcelona, Spain.
authors.forename: Susanna
authors.initials: S
authors.lastname: Coll
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Department of Medicine, Universitat Autonoma, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Garcia-Retortillo
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Cañete
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Fernández
authors.affiliation: Department of Pathology, Hospital del Mar, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gimeno
authors.affiliation: Radiology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchez
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Bory
authors.affiliation: IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Department of Medicine, Universitat Autonoma, Barcelona, Spain.|Endocrinology Department, Lipid Unit, Hospital del Mar, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Pedro-Botet
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Department of Medicine, Universitat Autonoma, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Solà
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Department of Medicine, Universitat Autonoma, Barcelona, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Carrión
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005234:Fatty Liver / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000473:pathology*; D050177:Overweight / Q000150:complications / Q000473:pathology*; D055815:Young Adult
keywords: accuracy; applicability; elastography; obesity; stiffness