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Background & Aims  Controlled attenuation parameter ( CAP ) is a non‐invasive method for evaluating hepatic steatosis. However, larger skin capsular distance ( SCD ) can affect the accuracy. The aim of this study was to investigate the impact of  SCD  on the diagnostic performance of  CAP  and liver stiffness measurement ( LSM ).    Methods  Of 101 patients with non‐alcoholic fatty liver disease ( NAFLD ) and 280 patients with chronic hepatitis B ( CHB ) who underwent liver biopsy were prospectively recruited.  CAP ,  LSM  and  SCD  were performed using FibroScan with M probe. The areas under receiver operating characteristics curves ( AUROC s) were calculated to determine the diagnostic efficacy. The optimal thresholds were defined by the maximum Youden index.    Results   SCD  (B 30.34,  P  <   0.001) and hepatic steatosis (B 23.04,  P  <   0.001) were independently associated with  CAP  by multivariate analysis. The  AUROC s were slightly higher for  SCD  <25 mm compared to those for  SCD  ≥25 mm for steatosis ≥5% (0.88 vs. 0.81), >33% (0.90 vs. 0.85) and >66% (0.84 vs. 0.72). For  SCD  <25 mm, the optimal  CAP  cut‐offs for differentiating steatosis ≥5%, >33% and >66% were 255.0  dB /m, 283.5  dB /m and 293.5  dB /m. However, cut‐offs were elevated by approximately 60–70  dB /m for  SCD  ≥25 mm. When stratified by fibrosis grade,  LSM  was significantly affected by  SCD  ≥25 mm for advanced fibrosis (≥F3) in  NAFLD , but not in CHB.    Conclusion   CAP  is a promising tool for detecting and quantifying hepatic steatosis.  SCD  ≥25 mm may cause overestimation of steatosis. Similarly,  SCD  ≥25 mm affects the detection of advanced fibrosis by  LSM  in  NAFLD  patients.

Impact of skin capsular distance on the performance of controlled attenuation parameter in patients with chronic liver disease