title: Controlled attenuation parameter using the FibroScan® XL probe for quantification of hepatic steatosis for non-alcoholic fatty liver disease in an Asian population.
abstract: BACKGROUND
  The FibroScan® XL probe reduces failure of liver stiffness measurement (LSM) and unreliable results in obese patients.
  
  
  OBJECTIVE
  The objective of this article is to evaluate the accuracy of controlled attenuation parameter (CAP) obtained using the XL probe for the estimation of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD).
  
  
  METHODS
  Adult NAFLD patients with a liver biopsy within six months were included and were examined with the FibroScan® M and XL probes. Histopathological findings were reported according to the Non-Alcoholic Steatohepatitis Clinical Research Network Scoring System. Participants who did not have fatty liver on ultrasonography were recruited as controls.
  
  
  RESULTS
  A total of 57 NAFLD patients and 22 controls were included. The mean age of the NAFLD patients and controls was 50.1 ± 10.4 years and 20.2 ± 1.3 years, respectively (p= 0.000). The mean body mass index was 30.2 ± 5.0 kg per m2and 20.5 ± 2.4 kg per m2, respectively (p= 0.000). The distribution of steatosis grades were: S0, 29%; S1, 17%; S2, 35%; S3, 19%. The AUROC for estimation of steatosis grade ≥ S1, S2 and S3 was 0.94, 0.80 and 0.69, respectively, using the M probe, and 0.97, 0.81 and 0.67, respectively, using the XL probe.
  
  
  CONCLUSIONS
  CAP obtained using the XL probe had similar accuracy as the M probe for the estimation of hepatic steatosis in NAFLD patients.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
authors.forename: Wah-Kheong
authors.initials: WK
authors.lastname: Chan
authors.affiliation: Department of Pathology, Hospital Sultanah Bahiyah, Malaysia.
authors.forename: Nik Raihan
authors.initials: NR
authors.lastname: Nik Mustapha
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
keywords: CAP; FibroScan; LSM; NAFLD; Non-alcoholic fatty liver disease; XL probe; controlled attenuation parameter; fibrosis; liver stiffness measurement; steatosis