Optimal cutoff value for assessing changes in intrahepatic fat amount by using the controlled attenuation parameter in a longitudinal setting

The controlled attenuation parameter (CAP) has shown a good correlation with the intrahepatic fat amount in cross-sectional studies. However, there is no study on whether the change of CAP scores can also show good correlation in a longitudinal setting. Therefore, we investigated the correlation between CAP and magnetic resonance imaging-estimated proton density fat fraction (MR PDFF) through serial examination in a longitudinal setting. Sixty-five patients with nonalcoholic fatty liver disease were evaluated with MR PDFF and transient elastography including CAP at baseline and 3 months later. The CAP and MR PDFF at baseline showed a strong correlation in assessing hepatic steatosis (r=0.66, P<. 001). After treatment, the correlation between the change in CAP after treatment and the intrahepatic fat change (%) on MR PDFF was not satisfactory (r=0.37, P=.005) in the longitudinal setting. The optimal cutoff value of the change in CAP for discriminating an improvement or an aggravation in intrahepatic fat percentage (>1% change in MR PDFF) was selected as 38dB/m (area under the receiver operating characteristic curve=0.559). For CAP changes>38dB/m, the predictive value was 14/16 (87.5%), whereas for changes< 38dB/m, the predictive value was 12/41 (29.3%). Thereby, the accuracy of the method using the change in CAP was only 26/57 (46%). In addition, Cohen's kappa value was not significant (k=0.11, P=.186). Careful interpretation of the steatosis change based on the CAP score is needed when the absolute change value is< 38dB/m in a longitudinal setting.