Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4959
Peer-review started: April 24, 2019
First decision: July 22, 2019
Revised: July 29, 2019
Accepted: August 7, 2019
Article in press: August 7, 2019
Published online: September 7, 2019
Liver stiffness measurement (LSM) tends to overestimate fibrosis stage in nonalcoholic fatty liver disease (NAFLD). Controlled attenuation parameter (CAP), provided by LSM device, has been introduced for noninvasive quantification of hepatic steatosis.
To determine the role of CAP values in predicting liver fibrosis stage by LSM in nonalcoholic steatohepatitis (NASH).
One hundred eighty-four patients with biopsy proven NASH had LSM and CAP evaluated at baseline. Among them, 130 patients had 1-year follow up LSM and analyzed for the changes of LSM after pioglitazone or ursodeoxycholic acid (UDCA) treatment.
In Kleiner fibrosis stage F0-1, LSM values increased at higher CAP tertile (P = 0.001), and in F2, at middle and higher tertiles (P = 0.027). No difference across CAP tertiles was noticed in F3-4 (P = 0.752). Receiver operating characteristic curve for LSM cutoff in diagnosis of F ≥ 2 identified 8.05 kPa for lower CAP tertile, 9.35 kPa for middle, and 10.55 kPa for high tertile. When changes in proportion of significant fibrosis (F ≥ 2) were assessed among pioglitazone and UDCA treated patients considering CAP values, pioglitazone treated patients demonstrated decrease in proportion of high LSM.
In patient with NAFLD, interpretation of LSM in association with CAP scores may provide helpful information sparing unnecessary liver biopsy.
Core tip: Liver stiffness measurement (LSM) is said to be exaggerated in nonalcoholic fatty liver disease (NAFLD). We investigated the role of controlled attenuation parameter (CAP), a means of measuring steatosis noninvasively, in predicting liver fibrosis by LSM in 184 biopsy proven nonalcoholic steatohepatitis patients. The optimum LSM cutoff for Kleiner fibrosis stage (F) ≥ 2 reflecting CAP values showed higher cutoff with increased CAP tertile (LSM, 8.05 kPa for lower CAP tertile, 9.35 kPa for middle, 10.45 kPa for high CAP tertile). Therefore, we suggest that interpretation of LSM in patients with NAFLD should take CAP scores into account in order to avoid unnecessary liver biopsy.