Digestive Diseases and Sciences

, Volume 62, Issue 9, pp 2569–2577 | Cite as

Controlled Attenuation Parameter (CAP) with the XL Probe of the Fibroscan®: A Comparative Study with the M Probe and Liver Biopsy

  • Victor de LédinghenEmail author
  • Jean-Baptiste Hiriart
  • Julien Vergniol
  • Wassil Merrouche
  • Pierre Bedossa
  • Valérie Paradis
Original Article



Controlled attenuation parameter (CAP) is a new method for the diagnosis of steatosis. Until now, CAP was available only with the M probe of the Fibroscan. The aim of this study was to evaluate the diagnostic performance of CAP with the XL probe versus CAP with the M probe, using liver biopsy (LB) as gold standard.

Patients and Methods

A total of 236 patients with chronic liver disease undergoing LB had CAP measurement with M and XL probes the same day. All LB were analyzed independently by two experienced pathologists.


Median CAP was 240.5 and 239.5 dB/m with the M and XL probes, respectively. For the detection of steatosis grade with the M and XL probes, AUROCs were 0.82/0.83 for S ≥ 1, 0.89/0.88 for S ≥ 2, and 0.92/0.93 for S3, respectively. Cutoffs were (M and XL probes) 246/242 for S ≥ 1, 269/267 for S ≥ 2, and 285/286 dB/m for S3, respectively. The factor significantly associated with CAP with the M and XL probes was steatosis grade. In multivariate analysis, a low CAP value with XL probe was negatively associated with waist circumference, triglycerides, albumin, and the alcohol consumption, and positively with alkaline phosphatases. In multivariate analysis, a high CAP value with the XL probe was positively associated with waist circumference and triglycerides.


CAP with the XL probe is a new tool for the diagnosis of steatosis. This parameter could be useful for the diagnosis and the follow-up of obese patients.


Controlled attenuation parameter (CAP) Liver stiffness Transient elastography Fibroscan Obesity NAFLD Metabolic syndrome Steatosis 



Controlled attenuation parameter


Liver biopsy


Area under the receiver operating curve (ROC)


Nonalcoholic fatty liver disease


Body mass index


Hepatitis B virus


Hepatitis C virus


Interquartile range


Liver stiffness measurement


Author’s contributions

VL performed research, analyzed data, designed research study, and wrote paper. JV performed research and analyzed data. JH, WM, and PB performed research. VP performed research and designed research study. All authors approved the final version of the manuscript.


Funding for this study was obtained from Echosens (Paris).

Compliance with ethical standards

Conflict of interest

Victor de Lédinghen: SuperSonic Imagine. Other authors: no conflict of interest.

Supplementary material

10620_2017_4638_MOESM1_ESM.tiff (447 kb)
Supplementary file Fig. 1. Controlled attenuation parameter (CAP) measured with the M probe versus the CAP measured with the XL probe


  1. 1.
    Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–131.CrossRefPubMedGoogle Scholar
  2. 2.
    Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148:547–555.CrossRefPubMedGoogle Scholar
  3. 3.
    Sasso M, Beaugrand M, de Ledinghen V, et al. Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36:1825–1835.CrossRefPubMedGoogle Scholar
  4. 4.
    Chon YE, Jung KS, Kim SU, et al. Controlled attenuation parameter (CAP) for detection of hepatic steatosis in patients with chronic liver diseases: a prospective study of a native Korean population. Liver Int. 2014;34:102–109.CrossRefPubMedGoogle Scholar
  5. 5.
    de Ledinghen V, Vergniol J, Capdepont M, et al. Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol. 2014;60:1026–1031.CrossRefPubMedGoogle Scholar
  6. 6.
    de Ledinghen V, Wong GL, Vergniol J, et al. Controlled attenuation parameter for the diagnosis of steatosis in non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2016;31:848–855.CrossRefPubMedGoogle Scholar
  7. 7.
    Karlas T, Petroff D, Sasso M, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol. 2017;66(5):1022–1030. doi: 10.1016/j.jhep.2016.12.022.CrossRefPubMedGoogle Scholar
  8. 8.
    Mi YQ, Shi QY, Xu L, et al. Controlled attenuation parameter for noninvasive assessment of hepatic steatosis using Fibroscan(R): validation in chronic hepatitis B. Dig Dis Sci. 2015;60:243–251.CrossRefPubMedGoogle Scholar
  9. 9.
    Sasso M, Miette V, Sandrin L, Beaugrand M. The controlled attenuation parameter (CAP): a novel tool for the non-invasive evaluation of steatosis using Fibroscan. Clin Res Hepatol Gastroenterol. 2012;36:13–20.CrossRefPubMedGoogle Scholar
  10. 10.
    Wong VW, Vergniol J, Wong GL, et al. Liver stiffness measurement using XL probe in patients with nonalcoholic fatty liver disease. Am J Gastroenterol. 2012;107:1862–1871.CrossRefPubMedGoogle Scholar
  11. 11.
    Sasso M, Audiere S, Kemgang A, et al. Liver steatosis assessed by controlled attenuation parameter (CAP) measured with the XL probe of the Fibroscan: a pilot study assessing diagnostic accuracy. Ultrasound Med Biol. 2016;42:92–103.CrossRefPubMedGoogle Scholar
  12. 12.
    de Ledinghen V, Vergniol J. Transient elastography (Fibroscan). Gastroenterol Clin Biol. 2008;32:58–67.CrossRefPubMedGoogle Scholar
  13. 13.
    Bedossa P, Poitou C, Veyrie N, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology. 2012;56:1751–1759.CrossRefPubMedGoogle Scholar
  14. 14.
    Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med. 2000;45:23–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Team. RC. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2015.
  16. 16.
    Chan WK, Nik Mustapha NR, Mahadeva S. Controlled attenuation parameter for the detection and quantification of hepatic steatosis in nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2014;29:1470–1476.CrossRefPubMedGoogle Scholar
  17. 17.
    Myers RP, Pollett A, Kirsch R, et al. Controlled attenuation parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography. Liver Int. 2012;32:902–910.CrossRefPubMedGoogle Scholar
  18. 18.
    WHO. Obesity and overweight—fact sheet n°311. WHO; 2015.
  19. 19.
    Torres DM, Williams CD, Harrison SA. Features, diagnosis, and treatment of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2012;10:837–858.CrossRefPubMedGoogle Scholar
  20. 20.
    Torres DM, Harrison SA. Diagnosis and therapy of nonalcoholic steatohepatitis. Gastroenterology. 2008;134:1682–1698.CrossRefPubMedGoogle Scholar
  21. 21.
    Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American association for the study of liver diseases, american college of gastroenterology, and the American gastroenterological association. Hepatology. 2012;55:2005–2023.CrossRefPubMedGoogle Scholar
  22. 22.
    Xu C, Yu C, Ma H, Xu L, Miao M, Li Y. Prevalence and risk factors for the development of nonalcoholic fatty liver disease in a nonobese Chinese population: the Zhejiang Zhenhai study. Am J Gastroenterol. 2013;108:1299–1304.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Victor de Lédinghen
    • 1
    • 2
    Email author
  • Jean-Baptiste Hiriart
    • 1
  • Julien Vergniol
    • 1
  • Wassil Merrouche
    • 1
  • Pierre Bedossa
    • 3
  • Valérie Paradis
    • 3
  1. 1.Centre d’Investigation de la Fibrose hépatique, Service d’Hépato-Gastroentérologie, Hôpital Haut-LévêqueCentre Hospitalo-Universitaire de BordeauxPessacFrance
  2. 2.INSERM U1053, Université BordeauxBordeauxFrance
  3. 3.Department of Pathology, Physiology and ImagingHôpital BeaujonClichyFrance

Personalised recommendations