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

Research output: Contribution to journalArticlepeer-review


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 languageEnglish
Pages (from-to)989-1000
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Issue number7
Publication statusPublished - Apr 2018


  • 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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