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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7236-7251
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7236
Transient elastography (FibroScan®) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand?
Ivana Mikolasevic, Lidija Orlic, Neven Franjic, Goran Hauser, Davor Stimac, Sandra Milic
Ivana Mikolasevic, Neven Franjic, Goran Hauser, Davor Stimac, Sandra Milic, Department of Gastroenterology, UHC Rijeka, 51000 Rijeka, Croatia
Lidija Orlic, Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, 51000 Rijeka, Croatia
Author contributions: Mikolasevic I researched the database, wrote the manuscript, and is the guarantor of this work; Milic S, Orlic L, Franjic N, Hauser G and Stimac D contributed to the discussion and reviewed/edited the manuscript.
Conflict-of-interest statement: The authors have no potential conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ivana Mikolasevic, MD, PhD, Department of Gastroenterology, UHC Rijeka, 51000 Rijeka, Croatia. ivana.mikolasevic@gmail.com
Telephone: +385-51-658122
Received: April 25, 2016
Peer-review started: April 26, 2016
First decision: May 30, 2016
Revised: June 28, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: August 28, 2016
Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Currently, the routinely used modalities are unable to adequately determine the levels of steatosis and fibrosis (laboratory tests and ultrasonography) or cannot be applied as a screening procedure (liver biopsy). Among the non-invasive tests, transient elastography (FibroScan®, TE) with controlled attenuation parameter (CAP) has demonstrated good accuracy in quantifying the levels of liver steatosis and fibrosis in patients with NAFLD, the factors associated with the diagnosis and NAFLD progression. The method is fast, reliable and reproducible, with good intra- and interobserver levels of agreement, thus allowing for population-wide screening and disease follow-up. The initial inability of the procedure to accurately determine fibrosis and steatosis in obese patients has been addressed with the development of the obese-specific XL probe. TE with CAP is a viable alternative to ultrasonography, both as an initial assessment and during follow-up of patients with NAFLD. Its ability to exclude patients with advanced fibrosis may be used to identify low-risk NAFLD patients in whom liver biopsy is not needed, therefore reducing the risk of complications and the financial costs.

Keywords: Non-alcoholic fatty liver disease, Transient elastography, Controlled attenuation parameter

Core tip: Non-alcoholic fatty liver disease (NAFLD) patients are at risk of NAFLD-related cirrhosis and hepatocellular carcinoma, particularly in the setting of liver fibrosis with concurrent metabolic syndrome. Transient elastography (TE) with controlled attenuation parameter (CAP) is a fast, reliable, repeatable non-invasive method for the assessment of liver steatosis and fibrosis. TE with CAP may be used to diagnose and monitor patients with NAFLD. TE with CAP is a favorable means of excluding advanced fibrosis.