Operational merit of Controlled Attenuation Parameter and Liver Stiffness Measurement across grades of Metabolic Dysfunctional Associated Steatotic Liver Disease: A cross-sectional study

Abstract Aim and objectives Metabolic dysfunction-associated steatotic liver disease (MASLD) contributes significantly to global NCD mortality. Often asymptomatic until advanced; early diagnosis prevents worsening. Given the limitations of liver biopsy, non-invasive tests (NITs) like Controlled Attenuation Parameter(CAP) and Liver Stiffness Measurement(LSM) offer promising alternatives. The present study aimed to correlate CAP with LSM and assess CAP and LSM accuracy for stratifying early steatosis and fibrosis using vibration-controlled transient elastography (VCTE). Methods The SmartExam ® equipment was used in patients at risk for or diagnosed with MASLD. This cross-sectional, prospective, tertiary care hospital-based study included 128 adult patients undergoing ultrasonography and/ or fibro-scan. Results Participants with steatosis grades 0-3 showed a significant increase in CAP and LSM with disease grades. A strong positive correlation existed between CAP and LSM (r=0.785, p<0.001), highlighting the interdependence of steatosis and liver stiffness. CAP demonstrated excellent diagnostic accuracy for hepatic steatosis (AUROC 1.000, p<0.001), showing substantial increases with steatosis progression. The sensitivity and specificity among individuals with high BMI/WHR were found to be 90.63% and 100% respectively, with a diagnostic accuracy of 97.66%. LSM showed marked elevation for advanced fibrosis, and the performance characteristics were found to be 81.25% sensitive, 82.29% specific, with a diagnostic accuracy of 82.03% in the higher BMI/WHR groups. Conclusion Our study confirms CAP’s excellent performance in diagnosing and stratifying hepatic steatosis and LSM’s potential role in assessing fibrosis, including early stages of MASLD. The strong CAP-LSM correlation promises synergistic utility across all stages of steatosis and liver stiffness.