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 journalArticle

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 languageEnglish
Pages (from-to)989-1000
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number7
DOIs
Publication statusPublished - Apr 2018

Keywords

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

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  • Cite this

    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