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Interobserver reproducibility of the controlled attenuation parameter (CAP) for quantifying liver steatosis

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Abstract

Purpose

This study was conducted to prospectively investigate the interobserver reproducibility of controlled attenuation parameter (CAP) measurements and the relationship among the CAP and body mass index (BMI), gender and age.

Methods

Consecutive subjects were studied using the M+ probe of the FibroScan device (Echosens, Paris, France). Measurements were performed by two raters (rater1 and rater2). Interobserver agreement was assessed by using the concordance correlation coefficient (CCC). The Pearson r coefficient was used to test correlation between two study variables, and linear regression was used for the multivariate model.

Results

Three hundred fifty-one subjects (227 males and 124 females) were prospectively studied. The CCC was 0.82 (95 % CI 0.78–0.85) overall, 0.80 (95 % CI 0.75–0.85) for BMI <25 kg/m2, 0.76 (95 % CI 0.69–0.84) for BMI 25–29 kg/m2 and 0.65 (95 % CI 0.41–0.88) for BMI ≥30 kg/m2. The CCC was 0.44 (95 % CI 0.31–0.56) for CAP values ≤240 dB/m and 0.72 (95 % CI 0.65–0.79) for CAP values >240 dB/m. In univariate analysis, age and BMI by gender were correlated with the CAP. Multiple regression analysis confirmed the relationship of the CAP with age and BMI, but not with gender.

Conclusions

The results of this study show that the interreader agreement in CAP measurement is good. In healthy volunteers, the CAP is strongly correlated with age and BMI.

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Acknowledgments

The authors would like to thank the nurses in the outpatient ward of the Infectious Diseases Department, including Ms. Livia Astroni, Ms. Natali Calabrese, Mr. Filippo Cuda, Mr. Lorenzo Guioli, Ms. Maura Marchisoni, Ms. Giampiera Nava, Ms. Loredana Pavesi and Ms. Barbara Ricci, the nurses in the “Medicina Diagnostica e dei Servizi” Department, including Ms. Paola Bolzoni, Ms. Anna Cuollo, Ms Giuseppina Discenza and Ms. Nadia Locatelli, the secretary of the Ultrasound Unit, for their valuable help in complying with the study protocol. The authors are very grateful to Magali Sasso, PhD, (Echosens, Paris) for her valuable advice on the CAP results.

Compliance with ethical requirements and Conflict of interest

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. Giovanna Ferraioli, Carmine Tinelli, Raffaella Lissandrin, Mabel Zicchetti, Mariangela Rondanelli, Guido Perani, Stefano Bernuzzi, Laura Salvaneschi and Carlo Filice declare that they have no conflict of interest. The members of the “Liver Steatosis Study Group” Elisabetta Above, Giorgio Barbarini, Raffaele Bruno, Silvia Corona, Carolina Dellafiore, Marta Di Gregorio, Roberto Gulminetti, Paolo Lanzarini, Serena Ludovisi, Laura Maiocchi, Antonello Malfitano, Giuseppe Michelone, Lorenzo Minoli, Mario Mondelli, Stefano Novati, Savino F.A. Patruno, Alessandro Perretti, Gianluigi Poma, Paolo Sacchi, Domenico Zanaboni and Marco Zaramella declare that they have no conflict of interest.

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Authors and Affiliations

  1. Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Via Taramelli 5, 27100, Pavia, Italy

    Giovanna Ferraioli, Raffaella Lissandrin, Mabel Zicchetti & Carlo Filice

  2. Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy

    Carmine Tinelli

  3. Department of Applied Health Sciences, Istituto di Cura “Santa Margherita”, University of Pavia, Via Emilia 12, 27100, Pavia, Italy

    Mariangela Rondanelli

  4. Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy

    Guido Perani

  5. Department of “Medicina Diagnostica e dei Servizi”, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy

    Stefano Bernuzzi & Laura Salvaneschi

Authors
  1. Giovanna Ferraioli
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  2. Carmine Tinelli
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  3. Raffaella Lissandrin
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  4. Mabel Zicchetti
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  5. Mariangela Rondanelli
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  6. Guido Perani
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  7. Stefano Bernuzzi
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  8. Laura Salvaneschi
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  9. Carlo Filice
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Corresponding author

Correspondence to Giovanna Ferraioli.

Additional information

On behalf of the Liver Steatosis Study Group.

Liver Steatosis Study Group

Elisabetta Above, MD, Giorgio Barbarini, MD, Raffaele Bruno, MD, Silvia Corona, MSc, Carolina Dellafiore, MD, Marta Di Gregorio, MD, Roberto Gulminetti, MD, Paolo Lanzarini, MD, Serena Ludovisi, MD, Laura Maiocchi, MD, Antonello Malfitano, MD, Giuseppe Michelone, MD, Lorenzo Minoli, MD, Mario Mondelli, MD, Stefano Novati, MD, Savino F.A. Patruno, MD, Alessandro Perretti, MD, Gianluigi Poma, MD, Paolo Sacchi, MD, Domenico Zanaboni, MD, and Marco Zaramella, MD.

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Ferraioli, G., Tinelli, C., Lissandrin, R. et al. Interobserver reproducibility of the controlled attenuation parameter (CAP) for quantifying liver steatosis. Hepatol Int 8, 576–581 (2014). https://doi.org/10.1007/s12072-014-9573-1

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  • DOI: https://doi.org/10.1007/s12072-014-9573-1

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