Advantages of CAPTM The Fibroscan (Echosens, France) is an innovative, non-invasive and® painless technique that assesses liver stiffness to give an immediate measure of hepatic fibrosis(10) . The machine uses a patented technique developed by Echosens called Vibration Controlled Transient Elastography at 50 Hz or VCTE. The Fibroscanprobe is fitted with an ultrasound transducer mounted® on the axis of a vibrator. This generates a low amplitude vibration, a little like a flick. A series of ultrasound acquisitions makes it possible to monitor the elastic wave generated by the vibration and to measure the speed at which it travels through the liver. This speed is directly related to tissue stiffness. The harder the medium, the faster theseonce at least 10% of the liver parenchyma is affected, giving more elastic waves will propagate. Stiffness, or elasticity, is expressed inprecise results than an ultra sound examination. Furthermore, the kilopascals (P ). This is a simple examination that can be done by aresults of this study showed that the differentiation of the various trained doctor or by trained nursing staff with the patient in a decu-grades of liver steatosis was more precise with CAP. The authors bitus dorsal position (12). Several studies conducted in patients withof this French multicentre study found the new CAP technology chronic hepatitis C have shown that this method is just as effective asto be a rapid, immediate and non-invasive means of measuring a liver biopsy for the diagnosis of cirrhosis(12, 13). CAP or the Controlledhepatic steatosis. Another study was conducted by the same team Attenuation Parameter is used to quantify liver steatosis. This newin 615 patients with chronic hepatitis C (13). Multivariate analysis technique is coupled with the FibroScan and measures ultrasound® showed that CAP measured (p l 10) and distinguished amongst-15 wave attenuation, which change depending mainly the viscositythe various grades of steatosis, independently of the extent of liver of the medium through which the waves travel. Both fibrosis andfibrosis. This study was the first to validate the usefulness of CAP steatosis are measured at the same time via M or XL probe placed onversus liver biopsy in patients with chronic hepatitis C. To confirm the patient’s skin. After repeating the procedure until 10 valid measu-the performance of CAP for the diagnosis of steatosis, a prospective, rements are obtained, the machine calculates the median elasticitymulticentre study conducted in France evaluated the method in value (corresponding to fibrosis) and a second value for ultrasound112 patients with liver damage (HCV, HBV, NAFLD and ALD) and com- attenuation (which represents the percentage of steatosis). Thesepared the results obtained with those of another non-invasive measu- results are obtained immediately and simultaneously. The elasticityrement method, the Stéatotest®(14). All these patients also underwent a value is expressed in kilopascals (P) and the CAP in decibels perliver biopsy. The results of this study showed that CAP was significant- metre (db/m). The whole examination takes less than ten minutes.ly correlated (Spearman coefficient) with the liver steatosis (r = 1.49, The utility of CAP has been explored in several studies conductedP < 0.0001) and fibrosis grades (r = 0.16, p = 0.02). recently in different patient populations. In a multicentre study invol-In conclusion, the authors of this study also confirmed that CAP was ving several French herpetology departments, Sasso et al. showeduseful for the detection of even minimal hepatic steatosis (10%). They that the new technology provided a precise and non-invasivefound that, when used in combination with the Fibroscan, this new® measurement of steatosis in patients (n = 115) with liver damagetechnique improved the simultaneous diagnosis of steatosis and caused by a variety of factors (12). This study showed that CAP is afibrosis, was non-invasive and could be used to monitor patients reliable means of quantifying steatosis since it detects the conditionwith chronic liver disease. BIBLIOGRAPHY 1. Van Hool M. Stéatose hépatique et NASH. Le Journal du Médecin. 2005:356-360 2. Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol. 2006 Mar;40 Suppl 1:S5-10. 3. Aubé C. Quantifier la stéatose hépatique, pourquoi ? comment ? J Radiol. 2009;90:1675. 4. Angulo P. GI epidemiology: nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2007 Apr 15;25:883-9. 5. Horsmans Y. La stéatose hépatique non alcoolique. Louvain Med. 2000;119:S23-S25. 6. Nomura H, Kashiwagi S, Hayashi J, et al. Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med. 1988;27(2):142-9. 7. Fang JG, Zhu J, Li XJ, et al. Epidemiological survey of prevalence of fatty liver and its risk factors in a general adult population of Shanghai. Zhonghua Gan Zang Bing Za Zhi. 2005;13(2):83-8. 8. Younossi ZM. Review article: current management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2008 Jul;28:2-12. 9. Kotronen A, Juurinen L, Tiikkainen M, Vehkavaara S, Yki-Järvinen H. Increased liver fat, impaired insulin clearance, and hepatic and adipose tissue insulin resistance in type 2 diabetes. Gastro enterology. 2008 Jul;135:122-30. 10. Melin P, et al. Dépistage non invasif de la fibrose hépatique. Intérêt du Fibroscan en consultation d’alcoologie. Alcoologie et addictologie. 2005;27:191-6. 11 Oneta CM, Dufour JF. Diagnostic, pronostic et possibilités thérapeutiques de la stéatose hépatique non alcoolique. Forum Med Suisse. 2003;37:862-8. 12. Sasso M, et al. Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and evaluation in a cohort of patients with chronic liver disease from various cases. Ultrasound in Med. & Biol. 2010;36(11):1825-35. 13. Sasso M, et al. Novel Controlled Attenuation Parameter (CAP) for noninvasive assessment of steatosis using Fibroscan®: validation in chronic hepatitis C? Journal of Viral Hepatitis. 2011. Ahead of print. 14. de Ledinghen V, et al. Non invasive diagnosis of steatosis using CAP by Fibroscan. A prospective study. EASL 2011. Oral presentation. 4psteatosis ENG- Revision date [12/12/14] - FibroScan® is a class IIa medical device according to Directive EC/93/42 and is manufactured by Echosens. Assessment of its conformity with the essential requi- rements of the Directive EC/93/42 is established by the LNE-G-MED (n°0459)- France - . FibroScan® is indicated for the non invasive measurement of liver stiffness (E) and controlled attenuation parameter (CAP) in humans. It is expressly recommended to carefully read the guidance within the users’ guide and labeling of the device. FibroScan® examination must only be performed by operators certified by the manufacturer or its accredited local representative. The values obtained with FibroScan® must be interpreted by a physician experienced in dealing with liver disease, taking into account the com- plete medical record of the patient. Our products are subject to regulatory requirements that vary from country to country and therefore may not be available for sale or distribution in all markets. This marketing material is not intended for US audience. 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