Objectives To analyze the diagnostic performance of tissue attenuation imaging (TAI), tissue scatter-distribution imaging (TSI) and ultrasound-based fat fraction (USFF) in suspected metabolic-associated fatty liver disease (MASLD), using histopathological hepatic steatosis as the reference standard. Materials and methods This was a retrospective analysis of prospectively recruited participants with suspected MASLD from August 2022 to November 2023. TAI, TSI and USFF were measured. Spearman correlation analysis was used to evaluate the correlation of TAI, TSI and USFF with hepatic steatosis. The diagnostic performance for detecting hepatic steatosis was evaluated by multiclass or binary receiver operating characteristic (ROC) curves. Results A total of 264 participants were enrolled, including 227 with biopsy-confirmed MASLD and 37 with normal liver biopsy results. Compared with TAI and TSI, USFF had a better positive correlation with hepatic steatosis in the overall set (rUSFF = 0.62, rTAI = 0.57, rTSI = 0.56; all p < 0.001). Multiclass ROC analysis indicated TAI, TSI and USFF exhibited only modest to suboptimal diagnostic performance for all hepatic steatosis (S0-S3) in index (volume under surface (VUS) 0.21–0.51) and validation set (VUS 0.18–0.34). However, binary ROC curves revealed TAI, TSI and USFF yielded the highest AUCs in detecting mild or greater hepatic steatosis in index (AUC 0.95–0.98) and validation set (AUC 0.92–0.96). Conclusions USFF has a good correlation with histopathological hepatic steatosis grade. TAI, TSI and USFF might be potential quantitative diagnostic tools for detecting mild hepatic steatosis in MASLD, though further validation in larger and more balanced cohorts is needed. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> How is the diagnostic performance of quantitative ultrasound parameters in suspected metabolic dysfunction-associated steatotic liver disease using liver biopsy as the reference standard? <Emphasis Type="BoldItalic">Findings</Emphasis> Tissue attenuation imaging, tissue scatter-distribution imaging and ultrasound-based fat fraction show promising diagnostic potential for mild hepatic steatosis in metabolic dysfunction-associated steatotic liver disease. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Tissue attenuation imaging, tissue scatter-distribution imaging, and ultrasound-based fat fraction might be potential noninvasive tools for detecting mild hepatic steatosis and conducting large-scale follow-ups in metabolic dysfunction-associated steatotic liver disease. Graphical Abstract

Ultrasound-based fat fraction for detection of hepatic steatosis and quantification of liver fat content using liver biopsy as the reference standard

期刊论文
发表日期：

2025年11月7日

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Chunya Ji,
Yixuan He,
Yunling Fan,
Anqi Zhu,
Hong Han,
Yao Miao,
Jifeng Yu,
Yuting Shen,
Siming Chen,
Yuli Zhu,
Huixiong Xu,
Haohao Yin

摘要

Objectives

To analyze the diagnostic performance of tissue attenuation imaging (TAI), tissue scatter-distribution imaging (TSI) and ultrasound-based fat fraction (USFF) in suspected metabolic-associated fatty liver disease (MASLD), using histopathological hepatic steatosis as the reference standard.

Materials and methods

This was a retrospective analysis of prospectively recruited participants with suspected MASLD from August 2022 to November 2023. TAI, TSI and USFF were measured. Spearman correlation analysis was used to evaluate the correlation of TAI, TSI and USFF with hepatic steatosis. The diagnostic performance for detecting hepatic steatosis was evaluated by multiclass or binary receiver operating characteristic (ROC) curves.

Results

A total of 264 participants were enrolled, including 227 with biopsy-confirmed MASLD and 37 with normal liver biopsy results. Compared with TAI and TSI, USFF had a better positive correlation with hepatic steatosis in the overall set (r_USFF = 0.62, r_TAI = 0.57, r_TSI = 0.56; all p < 0.001). Multiclass ROC analysis indicated TAI, TSI and USFF exhibited only modest to suboptimal diagnostic performance for all hepatic steatosis (S0-S3) in index (volume under surface (VUS) 0.21–0.51) and validation set (VUS 0.18–0.34). However, binary ROC curves revealed TAI, TSI and USFF yielded the highest AUCs in detecting mild or greater hepatic steatosis in index (AUC 0.95–0.98) and validation set (AUC 0.92–0.96).

Conclusions

USFF has a good correlation with histopathological hepatic steatosis grade. TAI, TSI and USFF might be potential quantitative diagnostic tools for detecting mild hepatic steatosis in MASLD, though further validation in larger and more balanced cohorts is needed.

Key Points

Question How is the diagnostic performance of quantitative ultrasound parameters in suspected metabolic dysfunction-associated steatotic liver disease using liver biopsy as the reference standard?

Findings Tissue attenuation imaging, tissue scatter-distribution imaging and ultrasound-based fat fraction show promising diagnostic potential for mild hepatic steatosis in metabolic dysfunction-associated steatotic liver disease.

Clinical relevance Tissue attenuation imaging, tissue scatter-distribution imaging, and ultrasound-based fat fraction might be potential noninvasive tools for detecting mild hepatic steatosis and conducting large-scale follow-ups in metabolic dysfunction-associated steatotic liver disease.

Graphical Abstract