• Salvatore Petta, Vincent Wai-Sun Wong, Calogero Cammà, Jean-Baptiste Hiriart, Grace Lai-Hung Wong, Fabio Marra, Julien Vergniol, Anthony Wing-Hung Chan, Vito Di Marco, Wassil Merrouche, Henry Lik-Yuen Chan, Marco Barbara, Brigitte Le-Bail, Umberto Arena, Antonio Craxì, and Victor de Ledinghen.
• Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy.
• Hepatology. 2017 Apr 1; 65 (4): 1145-1155.

AbstractLiver stiffness measurement (LSM) frequently overestimates the severity of liver fibrosis in nonalcoholic fatty liver disease (NAFLD). Controlled attenuation parameter (CAP) is a new parameter provided by the same machine used for LSM and associated with both steatosis and body mass index, the two factors mostly affecting LSM performance in NAFLD. We aimed to determine whether prediction of liver fibrosis by LSM in NAFLD patients is affected by CAP values. Patients (n = 324) were assessed by clinical and histological (Kleiner score) features. LSM and CAP were performed using the M probe. CAP values were grouped by tertiles (lower 132-298, middle 299-338, higher 339-400 dB/m). Among patients with F0-F2 fibrosis, mean LSM values, expressed in kilopascals, increased according to CAP tertiles (6.8 versus 8.6 versus 9.4, P = 0.001), and along this line the area under the curve of LSM for the diagnosis of F3-F4 fibrosis was progressively reduced from lower to middle and further to higher CAP tertiles (0.915, 0.848-0.982; 0.830, 0.753-0.908; 0.806, 0.723-0.890). As a consequence, in subjects with F0-F2 fibrosis, the rates of false-positive LSM results for F3-F4 fibrosis increased according to CAP tertiles (7.2% in lower versus 16.6% in middle versus 18.1% in higher). Consistent with this, a decisional flowchart for predicting fibrosis was suggested by combining both LSM and CAP values.© 2016 by the American Association for the Study of Liver Diseases.

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