Quantitative ultrasound analysis for non-invasive assessment of hepatic steatosis in metabolic dysfunction-associated steatotic liver disease

Objective To evaluate the diagnostic performance of novel tissue attenuation imaging (TAI) and tissue scatter distribution imaging (TSI) tools in detecting and grading hepatic steatosis using controlled attenuation parameter (CAP) as reference standard. Methods A total of 185 participants with suspected metabolic dysfunction-associated steatotic liver disease (MASLD) were prospectively enrolled, and all underwent CAP and quantitative ultrasound (QUS) testing. Correlations between CAP, biological data, TAI and TSI were assessed. The influence factors of TAI and TSI as well as the diagnostic performance of TAI and TSI in detecting hepatic steatosis were evaluated. Results The QUS parameters (TAI and TSI) showed good intra-observer reliability with ICC of 0.972 and 0.777, respectively. The correlation of CAP with TAI was higher than that of TSI (0.724 vs 0.360, P < 0.05). Multivariate Regression analysis showed that CAP was an important influence factor of TAI and TSI ( P < 0.001). The area under the ROC curve (CAP > 250 dB/m) of TAI and TSI tools for detecting hepatic steatosis was 0.876 (95% CI: 0.813–0.923; P < 0.0001) and 0.797(95% CI: 0.724–0.857; P < 0.001), respectively; the sensitivity was 67.18% and 83.21%, the specificity was 95.65% and 69.57%, and the cut-off values were 0.93 dB/cm/MHz and 91.28, respectively. When TAI and TSI were combined, the area under the ROC curve was 0.881, with a sensitivity of 80.92% and a specificity of 82.61%. The Delong test showed that the combined diagnosis of TAI and TSI was equivalent to the use of TAI alone ( P > 0.05). Conclusion TAI and TSI provided good intra-observer reliability, correlated well with CAP, and helped to detect and stage hepatic steatosis.