Detection of hepatic steatosis with ultrasound-guided attenuation parameter (UGAP) in metabolic dysfunction-associated steatotic liver disease (MASLD) compared with proton density fat fraction (PDFF): Impact of measurement number and region of interest (ROI) location

Abstract

Background:

The ultrasound-guided attenuation parameter is well established for hepatic steatosis detection in metabolic dysfunction-associated steatotic liver disease. The diagnostic performance of ultrasound-guided attenuation parameter was evaluated using different numbers of measurements at different lateral locations to detect hepatic steatosis ⩾ S1 in male and female patients with metabolic dysfunction-associated steatotic liver disease.

Methods:

A metabolic dysfunction-associated steatotic liver disease cohort was prospectively enrolled in autumn of 2022. Ultrasound-guided attenuation parameter values obtained through one to five measurements, performed at single and multiple locations, were compared with proton density fat fraction. Presence of hepatic steatosis (i.e. ⩾ S1) with ultrasound-guided attenuation parameter was defined as a proton density fat fraction of ⩾ 5%. Diagnostic performance was evaluated based on the area under the receiver operating characteristic curve.

Results:

Included 60 participants with an even sex distribution. Ultrasound-guided attenuation parameter diagnostic performance to detect hepatic steatosis ⩾ S1 did not significantly differ according to the number of measurements (from 1 to 5), different lateral locations, or patient sex. Ultrasound-guided attenuation parameter performed using five measurements in one location exhibited a receiver operating characteristic curve of 0.87 (95% confidence interval: 0.78, 0.97), and a threshold of 0.53 dB/cm/MHz, yielding 90% sensitivity and 65% specificity. Three measurements in multiple lateral locations exhibited a receiver operating characteristic curve of 0.91 (95% confidence interval: 0.84, 0.98), with a threshold of 0.58 dB/cm/MHz, yielding 95% sensitivity and 75% specificity.

Conclusion:

Ultrasound-guided attenuation parameter diagnostic performance to detect hepatic steatosis ⩾ S1 in metabolic dysfunction-associated steatotic liver disease is similar with regions of interest in single versus multiple lateral locations. Three measurements in multiple lateral locations appear sufficient to detect hepatic steatosis, which must be evaluated for all hepatic steatosis stages.