Controlled attenuation parameter by transient elastography for noninvasive assessment of macrovesicular steatosis in potential living liver donors
Sunyoung Lee2 , Kyoung Won Kim1 , So Yeon Kim1 , Nieun Seo2 , Gi-Won Song1 , Sung-Gyu Lee1
1Asan Medical Center, Seoul, Korea
2Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Corresponding Author: Kyoung Won Kim ,Tel: 82-2-3010-4400, Fax: 82-2-476-4719, Email:
Received: March 25, 2021;  Accepted: June 6, 2021.  Published online: June 6, 2021.
This study aimed to determine the diagnostic performance of controlled attenuation parameter (CAP) measured by transient elastography (TE) for assessing macrovesicular steatosis (MaS) in potential living liver donors using same-day biopsy as a reference standard.
This retrospective study included 204 living liver donor candidates who underwent TE and liver biopsy on the same day between July 2013 and June 2014. The histologic degree of MaS was determined. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of CAP for diagnosing MaS of >10%, and the optimal cutoff value was identified using the maximal Youden index.
Based on liver biopsy, 185 subjects had MaS of ≤10% and 19 had MaS of >10%. The CAP value was significantly correlated with the percentage of MaS on liver biopsy (r=0.635, P<0.001), and the median CAP value was significantly higher in subjects with MaS of >10% than in those with MaS of ≤10% (300 vs. 209 dB/m, P<0.001). The AUROC for diagnosing MaS of >10% by CAP was 0.938 (95% confidence interval, 0.896–0.967), with a CAP of >259 dB/m yielding a sensitivity of 84.2% and a specificity of 92.4%.
CAP by TE significantly correlates with MaS and accurately detects substantial MaS in potential living liver donors. The CAP is a promising tool for the noninvasive diagnosis of MaS and may be used to screen unsuitable living liver donor candidates.
Keywords: Controlled attenuation parameter; Transient elastography; Macrovesicular steatosis; Liver biopsy; Living donors
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