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. 2025 Apr;35(4):2339-2350.
doi: 10.1007/s00330-024-11076-w. Epub 2024 Oct 7.

Performance of ultrasound-guided attenuation parameter and 2D shear wave elastography in patients with metabolic dysfunction-associated steatotic liver disease

Roberto Cannella  1 , Francesco Agnello  2 , Giorgia Porrello  2 , Alessandro Umberto Spinello  2 , Giuseppe Infantino  3 , Grazia Pennisi  3 , Daniela Cabibi  4 , Salvatore Petta  3 , Tommaso Vincenzo Bartolotta  2
Affiliations

Performance of ultrasound-guided attenuation parameter and 2D shear wave elastography in patients with metabolic dysfunction-associated steatotic liver disease

Roberto Cannella et al. Eur Radiol. 2025 Apr.

Abstract

Purpose: To assess the performance and the reproducibility of ultrasound-guided attenuation parameter (UGAP) and two-dimensional shear wave elastography (2D-SWE) in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: This study included consecutive adult patients with MASLD who underwent ultrasound with UGAP, 2D-SWE and percutaneous liver biopsy. The median values of 12 consecutive UGAP measurements were acquired by two independent radiologists (R1 and R2). Hepatic steatosis was graded by liver biopsy as: (0) < 5%; (1) 5-33%; (2) > 33-66%; (3) > 66%. Areas under the curve (AUCs) were calculated to determine the diagnostic performance. Inter- and intra-observer reliability was assessed with intraclass correlation coefficient (ICC).

Results: A hundred patients (median age 55.0 years old) with MASLD were prospectively enrolled. At histopathology, 70 and 42 patients had grade ≥ 2 and 3 steatosis, respectively. Median UGAP was 0.78 dB/cm/MHz (IQR/Med: 5.55%). For the diagnosis of grade ≥ 2 steatosis, the AUCs of UGAP were 0.828 (95% CI: 0.739, 0.896) for R1 and 0.779 (95% CI: 0.685, 0.856) for R2. The inter- and intra-operator reliability of UGAP were excellent, with an ICC of 0.92 (95% CI: 0.87-0.95) and 0.95 (95% CI: 0.92-0.96), respectively. The median liver stiffness was 6.76 kPa (IQR/Med: 16.30%). For the diagnosis of advanced fibrosis, 2D-SWE had an AUC of 0.862 (95% CI: 0.757, 0.934), and the optimal cutoff value was > 6.75 kPa with a sensitivity of 80.6% and a specificity of 75.7%.

Conclusion: UGAP and 2D-SWE provide a good performance for the staging of steatosis and fibrosis in patients with MASLD with an excellent intra-operator reliability of UGAP.

Key points: Question How well do ultrasound-guided attenuation parameter (UGAP) and two-dimensional shear wave elastography (2D-SWE) perform for quantifying hepatic steatosis and fibrosis? Findings UGAP had a maximum AUC of 0.828 for the diagnosis of grade ≥ 2 steatosis, and 2D-SWE had an AUC of 0.862 for diagnosing advanced fibrosis. Clinical relevance UGAP and 2D-SWE allow rapid, reproducible, and accurate quantification of hepatic steatosis and fibrosis that can be used for the noninvasive assessment of patients with metabolic dysfunction-associated steatotic liver disease.

Keywords: Fatty liver; Fibrosis; Nonalcoholic fatty liver disease; Obesity; Ultrasonography.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is T.V.B. Conflict of interest: The authors of this manuscript declare relationships with the following companies: G.P. is a member of the Scientific Editorial Board (section: Oncology) for European Radiology. They did not participate in the selection or review processes for this article. R.C.: support for attending meetings from Bracco and Bayer; research collaboration with Siemens Healthineers. Statistics and biometry: One of the authors (R.C.) has significant statistical expertise. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: None of the subjects or cohorts have been previously reported. Preliminary data reported in this manuscript were presented at SIRM 2022, ECR 2023, and ESGAR 2023 meetings. Methodology: Prospective Diagnostic or prognostic study Performed at one institution

Figures

Fig. 1
Fig. 1
Plot box graphs with pairwise comparison of ultrasound-guided attenuation parameter (UGAP) measurements provided by the two radiologists (A: R1; B: R2) in different steatosis grades
Fig. 2
Fig. 2
Ultrasound-guided attenuation parameter (UGAP) measurements (upper row) with the corresponding attenuation map (middle row) and histopathological correlation (lower row). A 68-year-old male with median UGAP of 0.71 dB/cm/MHz and 20% hepatic steatosis at histopathological analysis. B 41-year-old male with median UGAP of 0.76 dB/cm/MHz and 50% hepatic steatosis at histopathological analysis. C 21-year-old male with median UGAP of 0.93 dB/cm/MHz and 90% hepatic steatosis at histopathological analysis
Fig. 3
Fig. 3
Receiver operating characteristic curves of ultrasound-guided attenuation parameter (UGAP) and controlled attenuation parameter (CAP) for the diagnosis of grade ≥ 2 (A) and grade 3 (B) steatosis
Fig. 4
Fig. 4
2D shear wave elastography (2D-SWE) liver stiffness measurements (upper row) with the corresponding histopathological correlation (lower row). A 21-year-old male with median liver stiffness measurement of 5.81 kPa and periportal fibrosis (F1c) at histopathological analysis. B 58-year-old female liver stiffness measurement of 10.59 kPa and periportal and bridging fibrosis with nodular transformation (F4) at histopathological analysis
Fig. 5
Fig. 5
Receiver operating characteristic curves of 2D shear wave elastography (2D-SWE) and transient elastography (TE) for the diagnosis of significant (A) and advanced (B) fibrosis
See this image and copyright information in PMC

References

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