*3.3. Controlled Attenuation Parameter*

The controlled attenuation parameter (CAP) was developed specifically for the FibroScan device to allow detection of hepatic steatosis in patients with about 10% of fatty hepatocyte degeneration without being influenced by liver fibrosis or cirrhosis. This threshold is clinically highly relevant because the diagnosis of steatosis is generally made when hepatic lipid content exceeds 5–10% by weight [115]. A significant correlation of the CAP signal and steatosis was first demonstrated in 2010 [116]. This study showed that CAP can efficiently separate grades of steatosis with AUROC values of 0.91 and 0.95 for the detection of more than 10% and 33% of steatosis. However, although

these characteristics are diagnostically promising, it should be critically mentioned that CAP increases after a meal across all stages of fibrosis, potentially leading to misclassification of patients when the operator does not adhere to preanalytical necessities [117].
