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CAP Value: Measuring Fatty Liver Non-Invasively

The CAP value (Controlled Attenuation Parameter) measures liver fat content non-invasively using ultrasound. It helps detect and grade fatty liver disease at an early stage.

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Things worth knowing about "CAP value"

The CAP value (Controlled Attenuation Parameter) measures liver fat content non-invasively using ultrasound. It helps detect and grade fatty liver disease at an early stage.

What is the CAP Value?

The CAP value (Controlled Attenuation Parameter) is a medical measurement that quantifies the fat content of the liver. It is obtained during a specialized ultrasound examination known as transient elastography (e.g., using the FibroScan® device). The technique measures how much ultrasound waves are attenuated – or weakened – as they pass through liver tissue. The greater the fat content, the stronger the attenuation.

The CAP value enables a non-invasive assessment of liver steatosis (fatty liver), eliminating the need for a liver biopsy (tissue sampling). Results are expressed in decibels per meter (dB/m) and typically range between 100 and 400 dB/m.

What is the CAP Value Used For?

The CAP value is used to assess the extent of hepatic steatosis (fatty liver disease). A fatty liver is present when more than 5% of liver cells contain fat deposits. Common causes include:

Excessive alcohol consumption (alcoholic fatty liver disease)
Overweight and obesity
Type 2 diabetes and insulin resistance
Lipid metabolism disorders
Certain medications

The CAP value is frequently measured alongside the Liver Stiffness Measurement (LSM), which provides information about possible liver fibrosis or cirrhosis.

How is the CAP Value Measured?

The examination is performed on an outpatient basis and is completely painless. The patient lies on their back while a trained clinician places an ultrasound probe on the upper right abdomen over the liver. The device emits sound waves and analyzes how much they are attenuated within the liver tissue. A single examination typically takes only a few minutes and is entirely non-invasive.

Interpreting the CAP Value

The CAP value is classified into grades of liver steatosis based on the following reference values:

Below 238 dB/m: No or minimal fat content (Steatosis grade S0)
238 – 259 dB/m: Mild fatty liver (Steatosis grade S1, approx. 5–33% of liver cells affected)
260 – 290 dB/m: Moderate fatty liver (Steatosis grade S2, approx. 34–66% of liver cells affected)
Above 290 dB/m: Severe fatty liver (Steatosis grade S3, more than 66% of liver cells affected)

These cut-off values may vary slightly depending on the device used and current study data. Results should always be interpreted by a physician within the appropriate clinical context.

Advantages and Limitations of the CAP Value

Advantages

Non-invasive: no biopsy required
Quick and painless to perform
Reproducible and well standardized
Simultaneous measurement of liver stiffness is possible

Limitations

Results may be less accurate in patients with severe obesity
Requires a certified specialized device (e.g., FibroScan®)
Not suitable as a standalone diagnostic tool for complex liver diseases
Individual factors (e.g., food intake before the examination) may influence results

When Should the CAP Value Be Measured?

A CAP value measurement may be indicated in cases of:

Suspected fatty liver disease (e.g., elevated liver enzymes in blood tests)
Monitoring the course of treatment in known fatty liver disease
Patients with risk factors such as obesity, type 2 diabetes, or lipid metabolism disorders
Follow-up after weight loss or lifestyle changes

References

Sasso M. et al. – Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis. Ultrasound in Medicine and Biology, 2010.
European Association for the Study of the Liver (EASL) – EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 2021.
Ferraioli G. et al. – Ultrasound-based techniques for the diagnosis of liver steatosis. World Journal of Gastroenterology, 2019.

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