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Meta-Analysis
. 2025 Nov;35(11):7421-7430.
doi: 10.1007/s00330-025-11652-8. Epub 2025 May 9.

Ultrasound-derived fat fraction for diagnosing hepatic steatosis: a systematic review and meta-analysis

Sarah Verdan  1 , Giovanni B Torri  2 , Vinícius Neves Marcos  3 , Maria Helena Silva Moreira  3 , Maria Luiza R Defante  4 , Marília da Cruz Fagundes  5 , Emanuela Mendes Junqueira de Barros  6 , Adriano B Dias  7 , Luyao Shen  8 , Stephan Altmayer  8
Affiliations
Meta-Analysis

Ultrasound-derived fat fraction for diagnosing hepatic steatosis: a systematic review and meta-analysis

Sarah Verdan et al. Eur Radiol. 2025 Nov.

Abstract

Objective: To perform a systematic review and meta-analysis to evaluate the diagnostic performance of Ultrasound-Derived Fat Fraction (UDFF) in detecting hepatic steatosis using Magnetic Resonance Imaging-Proton Density Fat Fraction (MRI-PDFF) as the reference standard.

Materials and methods: Relevant databases were searched through November 2024. Studies that evaluated the UDFF to detect hepatic steatosis using MRI-PDFF as the reference standard met the inclusion criteria. Our primary outcome was the sensitivity and specificity of UDFF compared to MRI-PDFF in distinguishing steatosis from non-steatosis. Analyses were performed using a bivariate random-effects approach, and heterogeneity was considered substantial if I2 > 50%. A sensitivity analysis was performed to detect potential studies that contribute to heterogeneity.

Results: Nine studies comprising 1150 patients (mean age range, 14-62 years; 51.2% women) were included. Eight studies were performed using the same vendor platform. The pooled sensitivity of UDFF for detecting hepatic steatosis was 90.4% (95% CI: 84.0%, 94.4%), and the pooled specificity was 83.8% (95% CI: 75.1%, 89.8%). The AUC for the summary receiver-operating characteristic curve was 0.93 (95% CI: 0.83, 0.95). Heterogeneity among the studies was low (I² = 22.2%).

Conclusion: UDFF demonstrates high sensitivity and specificity for detecting hepatic steatosis, supporting its value as a noninvasive tool for screening.

Key points: Question Small individual studies suggest that US-Derived Fat Fraction (UDFF) may effectively detect hepatic steatosis compared to MRI, but no meta-analysis has been performed. Findings In nine studies including 1150 patients, UDFF demonstrated high pooled sensitivity (90.4%) and specificity (83.8%) relative to MRI with low between-study heterogeneity. Clinical relevance UDFF demonstrates high diagnostic accuracy compared with MRI, supporting its use as a noninvasive tool with potentially lower cost and wider availability for large-scale screening of hepatic steatosis.

Keywords: Hepatic steatosis; MASLD; Magnetic resonance imaging; Nonalcoholic fatty liver disease (NAFLD); Ultrasonography.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Dr. Sarah Verdan. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors, Dr. Stephan Altmayer, has significant statistical expertise. Informed consent: Written informed consent was not required for this study because it is a systematic review and meta-analysis of previously published data. Ethical approval: Institutional Review Board approval was not required because this study is a systematic review and meta-analysis of previously published data. All included studies had already obtained ethical approval from their respective institutional review boards, as stated in their original publications. Study subjects or cohorts overlap: Some study subjects or cohorts have been previously reported in the original studies included in this systematic review and meta-analysis. Any potential overlap was carefully assessed to ensure that duplicate data did not bias the results. Methodology: Systematic review and meta-analysis

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