Accuracy of controlled attenuation parameter for liver steatosis in patients at risk for metabolic dysfunction-associated steatotic liver disease using magnetic resonance imaging: a systematic review and meta-analysis

Konstantinos Malandris; Anastasia Katsoula; Aris Liakos; Eleni Bekiari; Thomas Karagiannis; Eleni Theocharidou; Olga Giouleme; Emmanouil Sinakos; Apostolos Tsapas

Authors Konstantinos Malandris, Anastasia Katsoula, Aris Liakos, Eleni Bekiari, Thomas Karagiannis, Eleni Theocharidou, Olga Giouleme, Emmanouil Sinakos, Apostolos Tsapas.

Abstract

Background The controlled attenuation parameter (CAP) enables the noninvasive assessment of liver steatosis. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of CAP for identifying liver steatosis in patients at risk for metabolic dysfunctionassociated steatotic liver disease (MASLD), using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard.

Methods We searched Medline, Embase, Cochrane Library and gray literature sources up to March 2024. We defined MASLD as MRI-PDFF ≥5%. We also assessed the accuracy of CAP for identifying patients with MRI-PDFF ≥10%. We calculated pooled sensitivity and specificity estimates using hierarchical random-effects models. We assessed the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and the certainty in meta-analysis estimates using the Grading of Recommendations Assessment, Development and Evaluation framework.

Results We included 8 studies with 1116 participants. The prevalence of MASLD ranged from 65.2-93.9%. Pooled sensitivity and specificity of CAP for MRI-PDFF ≥5% were 0.84 (95% confidence interval [CI] 0.79-0.88) and 0.77 (95%CI 0.68-0.84), respectively, with an area under the receiver operating characteristic curve (AUROC) of 0.88. The pooled sensitivity and specificity for MRI-PDFF ≥10% were 0.83 (95%CI 0.80-0.87) and 0.72 (95%CI 0.59-0.82), with an AUROC of 0.85. The certainty in our estimates was low to very low because of the high risk of bias, inconsistency and imprecision.

Conclusions CAP has acceptable diagnostic accuracy for both MRI-PDFF ≥5% and MRI-PDFF ≥10%. Adequately powered and rigorously conducted diagnostic accuracy studies are warranted to establish the optimal CAP thresholds.

Keywords Controlled attenuation parameter, magnetic resonance imaging proton density fat fraction, metabolic dysfunction-associated steatotic liver disease, meta-analysis, diagnostic accuracy

Ann Gastroenterol 2024; 37 (5): 579-587