Diagnostic performance of quantitative ultrasonography for hepatic steatosis in a health screening program: a prospective single-center study

Purpose: This study compared the diagnostic performance of quantitative ultrasonography (QUS) with that of conventional ultrasonography (US) in assessing hepatic steatosis among individuals undergoing health screening using magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) as the reference standard. Methods: This single-center prospective study enrolled 427 participants who underwent abdominal MRI and US. Measurements included the attenuation coefficient in tissue attenuation imaging (TAI) and the scatter-distribution coefficient in tissue scatter-distribution imaging (TSI). The correlation between QUS and MRI-PDFF was evaluated. The diagnostic capabilities of QUS, conventional B-mode US, and their combined models for detecting hepatic fat content of >= 5% (MRI-PDFF >= 5%) and >= 10% (MRI-PDFF >= 10%) were compared by analyzing the areas under the receiver operating characteristic curves. Additionally, clinical risk factors influencing the diagnostic performance of QUS were identified using multivariate linear regression analyses. Results: TAI and TSI were strongly correlated with MRI-PDFF (r=0.759 and r=0.802, respectively; both P<0.001) and demonstrated good diagnostic performance in detecting and grading hepatic steatosis. The combination of QUS and B-mode US resulted in the highest areas under the ROC curve (AUCs) (0.947 and 0.975 for detecting hepatic fat content of >= 5% and >= 10%, respectively; both P<0.05), compared to TAI, TSI, or B-mode US alone (AUCs: 0.887, 0.910, 0.878 for >= 5% and 0.951, 0.922, 0.875 for >= 10%, respectively). The independent determinants of QUS included skin- liver capsule distance (R=7.134), R=7.134), hepatic fibrosis (R=4.808), R=4.808), alanine aminotransferase (R=0.202), R=0.202), triglyceride levels (R=0.027), R=0.027), and diabetes mellitus (R=3.710). R=3.710). Conclusion: QUS is a useful and effective screening tool for detecting and grading hepatic steatosis during health checkups.