Quantitative Liver Fat Assessment by Handheld Point-of-Care Ultrasound: A Technical Implementation and Pilot Study in Adults

Dorathy Tamayo-Murillo¹, Jake T Weeks², Cody A Keller², Michael Andre³, Celene Gonzalez², Andrew Li⁴, Eduardo Grunvald⁵, Joy Liau³, Sedighe Hosseini Shabanan², Tanya Wolfson⁶, Jingyi Zuo⁷, Adam Robinson³, Carolina Amador Carrascal⁸, Nevada Sanchez⁸, Scott B Reeder⁹, Aiguo Han⁷, Claude B Sirlin²

Affiliations

¹ Department of Radiology, University of California San Diego, La Jolla, CA, USA. Electronic address: dtamayomurillo@health.ucsd.edu.
² Department of Radiology, Liver Imaging Group, University of California San Diego, La Jolla, CA, USA.
³ Department of Radiology, University of California San Diego, La Jolla, CA, USA.
⁴ Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
⁵ UCSD Center for Advanced Weight Management, Division of General Internal Medicine, University of California San Diego, La Jolla, CA, USA.
⁶ Department of Medicine, Computer And Statistics Laboratory, University of California San Diego, La Jolla, CA, USA.
⁷ Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blackburg, VA, USA.
⁸ Butterfly Network Inc., Burlington, MA, USA.
⁹ Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, Madison, WI, USA.

PMID: 39690042
PMCID: PMC12258410 (available on 2026-03-01)
DOI: 10.1016/j.ultrasmedbio.2024.11.005

Quantitative Liver Fat Assessment by Handheld Point-of-Care Ultrasound: A Technical Implementation and Pilot Study in Adults

Dorathy Tamayo-Murillo et al. Ultrasound Med Biol. 2025 Mar.

. 2025 Mar;51(3):475-483.

doi: 10.1016/j.ultrasmedbio.2024.11.005. Epub 2024 Dec 16.

Authors

Affiliations

¹ Department of Radiology, University of California San Diego, La Jolla, CA, USA. Electronic address: dtamayomurillo@health.ucsd.edu.
² Department of Radiology, Liver Imaging Group, University of California San Diego, La Jolla, CA, USA.
³ Department of Radiology, University of California San Diego, La Jolla, CA, USA.
⁴ Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
⁵ UCSD Center for Advanced Weight Management, Division of General Internal Medicine, University of California San Diego, La Jolla, CA, USA.
⁶ Department of Medicine, Computer And Statistics Laboratory, University of California San Diego, La Jolla, CA, USA.
⁷ Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blackburg, VA, USA.
⁸ Butterfly Network Inc., Burlington, MA, USA.
⁹ Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, Madison, WI, USA.

PMID: 39690042
PMCID: PMC12258410 (available on 2026-03-01)
DOI: 10.1016/j.ultrasmedbio.2024.11.005

Abstract

Objectives: To implement, examine the feasibility of, and evaluate the performance of quantitative ultrasound (QUS) with a handheld point-of-care US (POCUS) device for assessing liver fat in adults.

Materials and methods: This prospective IRB-approved, HIPAA-compliant pilot study enrolled adults with overweight or obesity. Participants underwent chemical-shift-encoded magnetic resonance imaging to estimate proton density fat fraction (PDFF) and, within 1 mo, QUS with a POCUS device by expert sonographers and novice operators (no prior US scanning experience). Radiofrequency data from the liver collected with the POCUS device were analyzed offline using probe-specific calibrations to estimate two QUS parameters: attenuation coefficient (AC) and backscatter coefficient (BSC). Area under the receiver operating characteristic curve (AUC) of each parameter was estimated for classifying presence/absence of hepatic steatosis (defined as PDFF ≥ 5%). Spearman rank correlation between each parameter and PDFF was estimated and its significance assessed.

Results: Of 18 participants (mean age, 43 y ± 14; 17 women), 8 had hepatic steatosis (PDFF ≥ 5%). Both AC and BSC classified hepatic steatosis accurately with AUCs of 0.96-0.97 for expert and 0.88-0.89 for novice operators (p < 0.01 for all) and correlated significantly with PDFF with rho's of 0.65-0.69 for expert and 0.58-0.65 for novice operators (p < 0.02 for all).

Conclusion: QUS can be implemented on a POCUS device and can be performed by expert or novice operators after limited training in adults with overweight or obesity with promising initial results.

Keywords: Biomarkers; Diagnosis; Fatty liver; Magnetic resonance imaging; Ultrasonography.

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Conflict of interest statement

Conflict of interest The authors of this manuscript declare relationships with the following companies: Dr. Sirlin reports payment to institution for research grants from ACR, Bayer, Foundation of NIH, GE, Gilead, Pfizer, Philips, Siemens, V Foundation; payment to institution for lab service agreements with OrsoBio, Enanta, Gilead, ICON, Intercept, Nusirt, Shire, Synageva, Takeda; payment to institution for institutional consulting for BMS, Exact Sciences, IBM-Watson, Pfizer; Personal consulting for Altimmune, Ascelia Pharma, Blade, Boehringer, Epigenomics, Guerbet, and Livivos; payment to self for royalties and/or honoraria from Medscape and Wolters Kluwer; ownership of stock options in Livivos; unpaid advisory board position in Quantix Bio; executive position for Livivos (Chief Medical Officer, unsalaried position with stock options and stock) through June 28, 2023; Principal Scientific Advisor to Livivos (unsalaried position with stock options and stock) since June 28, 2023; support for attending meetings and/or travel from Fundacion Santa Fe, Congreso Argentino de Diagnóstico por Imágenes, Stanford, Jornada Paulista de Radiologia, Ascelia Pharma, RSNA, Sociedad Radiológica de Puerto Rico, Hospital Español Auxilio Mutuo de Puerto Rico; member (no payment) of Data Safety Monitoring board for National Cancer Institute funded Early Detection Research Network; equipment loans to institution from GE, Siemens, and Mayo; provision of contrast material to institution from Bayer. Dr. Reeder has no relevant conflicts. Unrelated to this work, Dr. Reeder has ownership interests in Calimetrix, Reveal Pharmaceuticals, Cellectar Biosciences, Elucent Medical, HeartVista, and RevOps. Dr. Reeder provides consulting services to Bracco Diagnostics, ProTara, Bayer Healthcare, and Marea Therapeutics. Further, the University of Wisconsin receives research support from GE Healthcare, Bracco Diagnostics, Bayer Healthcare, and Pfizer. Dr. Amador and Mr. Sanchez have conflicts of interest, as they are both employed by Butterfly Network Inc. Dr. Andre reports payment to institution for research grants from US Department of Defense, National Institutes of Health, US Department of Veterans Affairs, and V Foundation. Dr. Han reports payment to institution for research grants from Carilion Clinic, US Department of Defense, Focused Ultrasound Foundation, National Institutes of Health, Siemens, V Foundation, and Virginia Commonwealth Cyber Initiative. The remaining authors report no conflicts of interest.

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Quantitative Liver Fat Assessment by Handheld Point-of-Care Ultrasound: A Technical Implementation and Pilot Study in Adults

Affiliations

Quantitative Liver Fat Assessment by Handheld Point-of-Care Ultrasound: A Technical Implementation and Pilot Study in Adults

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical