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© 2025. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Purpose

This study assessed the impact of hepatic fibrosis on the diagnostic performance of the controlled attenuation parameter (CAP) in quantifying hepatic steatosis in patients with chronic hepatitis B (CHB).

Methods

CHB patients who underwent liver stiffness measurement (LSM) and CAP assessment using transient elastography before liver resection between 2019 and 2022 were retrospectively evaluated. Clinical data included body mass index (BMI) and laboratory parameters. The histologically determined hepatic fat fraction (HFF) and fibrosis stages were reviewed by pathologists blinded to clinical and radiologic data. The Pearson correlation coefficient between CAP and HFF was calculated. The diagnostic performance of CAP for significant hepatic steatosis (HFF ≥10%) was assessed using areas under the receiver operating curve (AUCs), stratified by fibrosis stages (F0-1 vs. F2-4). Factors significantly associated with CAP were determined by univariable and multivariable linear regression analyses.

Results

Among 399 CHB patients (median age 59 years; 306 men), 16.3% showed significant steatosis. HFF ranged from 0% to 60%. Of these patients, 9.8%, 19.8%, 29.3%, and 41.1% had fibrosis stages F0-1, F2, F3, and F4, respectively. CAP positively correlated with HFF (r=0.445, P<0.001). The AUC of CAP for diagnosing significant steatosis was 0.786 (95% confidence interval [CI], 0.726 to 0.845) overall, and significantly lower in F2-4 (0.772; 95% CI, 0.708 to 0.836) than in F0-1 (0.924; 95% CI, 0.835 to 1.000) (P=0.006). Multivariable analysis showed that BMI (P<0.001) and HFF (P<0.001) significantly affected CAP, whereas LSM and fibrosis stages did not.

Conclusion

CAP evaluations of significant hepatic steatosis are less reliable in CHB patients with significant or more advanced (F2-4) than with no or mild (F0-1) fibrosis.

Key points

In chronic hepatitis B (CHB) patients, the correlation coefficient between controlled attenuation parameter (CAP) and the histologically determined hepatic fat fraction was lower in patients with fibrosis stages F2-4 (r=0.443) than in those with F0-1 (r=0.527). CAP was less accurate in diagnosing significant hepatic steatosis in CHB patients with significant or more advanced hepatic fibrosis than in those with no or mild fibrosis. The results of CAP quantification of hepatic steatosis by transient elastography in patients with severe fibrosis should be interpreted cautiously.

Details

Title
Effects of hepatic fibrosis on the quantification of hepatic steatosis using the controlled attenuation parameter in patients with chronic hepatitis B
Author
Park, Hee Jun  VIAFID ORCID Logo  ; Hyo Jeong Kang  VIAFID ORCID Logo  ; Kim, So Yeon  VIAFID ORCID Logo  ; Yoon, Seonghun  VIAFID ORCID Logo  ; Baek, Seunghee  VIAFID ORCID Logo  ; In Hye Song  VIAFID ORCID Logo  ; Hyeon Ji Jang  VIAFID ORCID Logo  ; Jong Keon Jang  VIAFID ORCID Logo 
Pages
83-91
Section
Original Article
Publication year
2025
Publication date
Jan 2025
Publisher
Korean Society of Ultrasound in Medicine
ISSN
22885919
e-ISSN
22885943
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3158272315
Copyright
© 2025. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.