Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 23.
doi: 10.1002/jum.70005. Online ahead of print.

Evaluation of Hepatic Steatosis and Fibrosis in Steatotic Liver Disease Ultrasound-Derived Fat Fraction (UDFF) and Auto pSWE by Using Deep Abdominal Transducer (DAX) and Liver Biopsy Correlation

Ahmet Burak Kale  1 , Mustafa Faraşat  1 , Gökhan Pekindil  1 , Semin Ayhan  2 , Serdar Tarhan  1 , Tahir Buran  3
Affiliations

Evaluation of Hepatic Steatosis and Fibrosis in Steatotic Liver Disease Ultrasound-Derived Fat Fraction (UDFF) and Auto pSWE by Using Deep Abdominal Transducer (DAX) and Liver Biopsy Correlation

Ahmet Burak Kale et al. J Ultrasound Med. .

Abstract

Objectives: To evaluate the diagnostic performance of ultrasound-derived fat fraction (UDFF) in detecting and grading hepatosteatosis using liver histology as the reference, and to assess the effectiveness of point shear wave elastography (pSWE), UDFF, and auto-pSWE in diagnosing steatohepatitis and detecting fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: In this prospective study, patients underwent liver biopsy following UDFF and pSWE measurements using deep abdominal transducer (DAX) and conventional abdominal probes by 2 operators. Imaging findings were compared with histopathology to assess diagnostic performance. Associations between nonalcoholic fatty liver disease activity score (NAS), fibrosis stage, and imaging parameters were also evaluated.

Results: A total of 121 patients were included. The median age was 50 years, and 57 (41%) were male. Histology confirmed steatotic liver disease in 43 cases. Excellent interobserver agreement was observed for UDFF (ICC = 0.974), pSWE (ICC = 0.958), and auto-pSWE (ICC = 0.960). UDFF showed a stepwise increase with steatosis grade and was moderately correlated with histological fat content (r = 0.676 for Sonographer 1, r = 0.638 for Sonographer 2; P < .001). For detecting S ≥ 1 steatosis, the optimal UDFF thresholds were ≥8.4% (Area Under the Curve (AUC) = 0.968; Se = 92.5%, Sp = 93.2%) for Sonographer 1 and ≥8.6% (AUC = 0.951; Se = 90.0%, Sp = 86.3%) for Sonographer 2. For moderate steatosis (S ≥ 2), the cutoffs were ≥10.4% (AUC = 0.932; Se = 100%, Sp = 79.6%) and ≥10.6% (AUC = 0.925; Se = 100%, Sp = 76.5%), and for severe steatosis (S = 3), ≥18.3% (AUC = 0.961; Se = 100%, Sp = 77.4%) and ≥18.7% (AUC = 0.949; Se = 100%, Sp = 77.4%) for Sonographer 1 and 2, respectively. UDFF positively correlated with body mass index and subcutaneous fat thickness, and negatively with both pSWE and auto-pSWE. A strong correlation was observed between pSWE and auto-pSWE for both observers. A weak positive correlation was found between NAS and auto-pSWE in MASLD cases. The optimal thresholds to detect fibrosis (≥F1) were 5.05 and 4.95 kPa for Sonographer 1, and 5.05 and 4.85 kPa for Sonographer 2, for pSWE and auto-pSWE measurements, respectively.

Conclusion: DAX-derived UDFF and auto-pSWE are reproducible, noninvasive biomarkers with strong diagnostic value in assessing steatosis and fibrosis in MASLD.

Keywords: deep abdominal transducer (DAX); fibrosis; liver biopsy; quantitative ultrasound; steatotic liver disease; ultrasound‐derived fat fraction (UDFF).

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023; 78:1966–1986. https://doi.org/10.1097/HEP.0000000000000520.
    1. Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology 2023; 77:1335–1347. https://doi.org/10.1097/HEP.0000000000000004.
    1. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non‐alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142:1592–1609. https://doi.org/10.1053/J.GASTRO.2012.04.001.
    1. Rinella ME, Neuschwander‐Tetri BA, Siddiqui MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 2023; 77:1797–1835. https://doi.org/10.1097/HEP.0000000000000323.
    1. Saadeh S, Younossi ZM, Remer EM, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123:745–750. https://doi.org/10.1053/gast.2002.35354.

LinkOut - more resources