Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

T Karlas; D Petroff; M Sasso; J-G Fan; Y-Q Mi; V de Lédinghen; M Kumar; M Lupsor-Platon; K-H Han; A C Cardoso; G Ferraioli; W-K Chan; V W-S Wong; R P Myers; K Chayama; M Friedrich-Rust; M Beaugrand; F Shen; J-B Hiriart; S K Sarin; R Badea; H W Lee; P Marcellin; C Filice; S Mahadeva; G L-H Wong; P Crotty; K Masaki; J Bojunga; P Bedossa; V Keim; J Wiegand

doi:10.1111/apt.14529

Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

T Karlas, D Petroff, M Sasso, J-G Fan, Y-Q Mi, V de Lédinghen, M Kumar, M Lupsor-Platon, K-H Han, A C Cardoso, G Ferraioli, W-K Chan, V W-S Wong, R P Myers, K Chayama, M Friedrich-Rust, M Beaugrand, F Shen, J-B Hiriart, S K SarinR Badea, H W Lee, P Marcellin, C Filice, S Mahadeva, G L-H Wong, P Crotty, K Masaki, J Bojunga, P Bedossa, V Keim, J Wiegand

IRCCS Fondazione Policlinico San Matteo

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. AIM: To determine how to use CAP in interpreting liver stiffness measurements. METHODS: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. RESULTS: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. CONCLUSIONS: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

Original language	English
Pages (from-to)	989-1000
Number of pages	12
Journal	Alimentary Pharmacology and Therapeutics
Volume	47
Issue number	7
DOIs	https://doi.org/10.1111/apt.14529
Publication status	Published - Apr 2018

Keywords

Adult
Biopsy
Elasticity
Elasticity Imaging Techniques/*methods
Female
Humans
Liver/*diagnostic imaging/pathology
Liver Cirrhosis/*diagnosis/pathology/physiopathology
Liver Function Tests/methods/standards
Male
Middle Aged
Non-alcoholic Fatty Liver Disease/diagnosis/pathology
Retrospective Studies
Sensitivity and Specificity

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10.1111/apt.14529

https://pubmed.ncbi.nlm.nih.gov/29446106

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Karlas, T., Petroff, D., Sasso, M., Fan, J-G., Mi, Y-Q., de Lédinghen, V., Kumar, M., Lupsor-Platon, M., Han, K-H., Cardoso, A. C., Ferraioli, G., Chan, W-K., Wong, V. W-S., Myers, R. P., Chayama, K., Friedrich-Rust, M., Beaugrand, M., Shen, F., Hiriart, J-B., ... Wiegand, J. (2018). Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement. Alimentary Pharmacology and Therapeutics, 47(7), 989-1000. https://doi.org/10.1111/apt.14529

Karlas, T, Petroff, D, Sasso, M, Fan, J-G, Mi, Y-Q, de Lédinghen, V, Kumar, M, Lupsor-Platon, M, Han, K-H, Cardoso, AC, Ferraioli, G, Chan, W-K, Wong, VW-S, Myers, RP, Chayama, K, Friedrich-Rust, M, Beaugrand, M, Shen, F, Hiriart, J-B, Sarin, SK, Badea, R, Lee, HW, Marcellin, P, Filice, C, Mahadeva, S, Wong, GL-H, Crotty, P, Masaki, K, Bojunga, J, Bedossa, P, Keim, V & Wiegand, J 2018, 'Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement', Alimentary Pharmacology and Therapeutics, vol. 47, no. 7, pp. 989-1000. https://doi.org/10.1111/apt.14529

@article{e40f02640d71403b924c7372aefab04e,

title = "Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement",

abstract = "BACKGROUND: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. AIM: To determine how to use CAP in interpreting liver stiffness measurements. METHODS: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. RESULTS: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. CONCLUSIONS: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.",

keywords = "Adult, Biopsy, Elasticity, Elasticity Imaging Techniques/*methods, Female, Humans, Liver/*diagnostic imaging/pathology, Liver Cirrhosis/*diagnosis/pathology/physiopathology, Liver Function Tests/methods/standards, Male, Middle Aged, Non-alcoholic Fatty Liver Disease/diagnosis/pathology, Retrospective Studies, Sensitivity and Specificity",

author = "T Karlas and D Petroff and M Sasso and J-G Fan and Y-Q Mi and {de L{\'e}dinghen}, V and M Kumar and M Lupsor-Platon and K-H Han and Cardoso, {A C} and G Ferraioli and W-K Chan and Wong, {V W-S} and Myers, {R P} and K Chayama and M Friedrich-Rust and M Beaugrand and F Shen and J-B Hiriart and Sarin, {S K} and R Badea and Lee, {H W} and P Marcellin and C Filice and S Mahadeva and Wong, {G L-H} and P Crotty and K Masaki and J Bojunga and P Bedossa and V Keim and J Wiegand",

year = "2018",

month = apr,

doi = "10.1111/apt.14529",

language = "English",

volume = "47",

pages = "989--1000",

journal = "Alimentary Pharmacology and Therapeutics",

issn = "0269-2813",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "7",

}

TY - JOUR

T1 - Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

AU - Karlas, T

AU - Petroff, D

AU - Sasso, M

AU - Fan, J-G

AU - Mi, Y-Q

AU - de Lédinghen, V

AU - Kumar, M

AU - Lupsor-Platon, M

AU - Han, K-H

AU - Cardoso, A C

AU - Ferraioli, G

AU - Chan, W-K

AU - Wong, V W-S

AU - Myers, R P

AU - Chayama, K

AU - Friedrich-Rust, M

AU - Beaugrand, M

AU - Shen, F

AU - Hiriart, J-B

AU - Sarin, S K

AU - Badea, R

AU - Lee, H W

AU - Marcellin, P

AU - Filice, C

AU - Mahadeva, S

AU - Wong, G L-H

AU - Crotty, P

AU - Masaki, K

AU - Bojunga, J

AU - Bedossa, P

AU - Keim, V

AU - Wiegand, J

PY - 2018/4

Y1 - 2018/4

N2 - BACKGROUND: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. AIM: To determine how to use CAP in interpreting liver stiffness measurements. METHODS: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. RESULTS: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. CONCLUSIONS: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

AB - BACKGROUND: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. AIM: To determine how to use CAP in interpreting liver stiffness measurements. METHODS: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. RESULTS: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. CONCLUSIONS: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

KW - Adult

KW - Biopsy

KW - Elasticity

KW - Elasticity Imaging Techniques/methods

KW - Female

KW - Humans

KW - Liver/diagnostic imaging/pathology

KW - Liver Cirrhosis/diagnosis/pathology/physiopathology

KW - Liver Function Tests/methods/standards

KW - Male

KW - Middle Aged

KW - Non-alcoholic Fatty Liver Disease/diagnosis/pathology

KW - Retrospective Studies

KW - Sensitivity and Specificity

U2 - 10.1111/apt.14529

DO - 10.1111/apt.14529

M3 - Article

VL - 47

SP - 989

EP - 1000

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 7

ER -

Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

Abstract

Keywords

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