Comparing attenuation parameter and liver stiffness measurement using Hepatus and Fibroscan for the evaluation of steatosis and fibrosis in patients with chronic liver disease: A prospective study

Background There are limited studies comparing Hepatus (HP), a novel visual transient elastography device with Fibroscan (FS), one of the most studied and validated non-invasive tests in the field of hepatology. Methodology HP and FS examinations were performed on patients with chronic liver disease by two operators, healthcare providers from different background, twice on each patient, at two different time points, independent of each other. Results The data for 158 patients with 1264 examinations was analysed. There was moderate to strong correlation for attenuation parameter (Spearman’s rho 0.67, p < 0.001) and liver stiffness measurement (LSM) (Spearman’s rho 0.74, p < 0.001) obtained using the two devices. The mean difference (95% limits of agreement) in measurements was 15 (−69–99) dB/m for attenuation parameter and 1.2 (−5.0–7.2) kPa for LSM. There was fair to moderate agreement for diagnosis of steatosis grade >S0, > S1 and >S2 and substantial agreement for diagnosis of unlikely and likely compensated advanced chronic liver disease. The interquartile range (IQR) for attenuation parameter and IQR/median for LSM were lower for HP compared with FS (12 dB/m vs 33 dB/m, p < 0.001, and 13% vs 14%, p < 0.001, respectively). The intra- and inter-observer reliability using both devices were good to excellent with intraclass correlation coefficients of 0.86–0.97. Subgroup analyses demonstrated that agreement between HP and FS was maintained across obese and non-obese patients as well as patients with viral hepatitis and metabolic dysfunction-associated steatotic liver disease. HP had shorter examination time (43 s vs 62 s, p < 0.001) and fewer invalid measurements (0 vs 1, p < 0.001). Conclusion HP demonstrated good comparability and reproducibility with FS for the assessment of hepatic steatosis and fibrosis, with shorter examination time and fewer invalid measurements.