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. 2025 Dec;46(6):603-613.
doi: 10.1055/a-2592-1431. Epub 2025 Aug 7.

UDFF and Auto pSWE accurately assess liver steatosis and fibrosis risk in obese patients with MASLD

Nina Dominik  1   2 , Larissa Nixdorf  3 , Michael Schwarz  1   2 , Benedikt Silvester Hofer  1   2 , Lukas Hartl  1   2 , Lorenz Balcar  1   2 , Georg Semmler  1   2 , Benedikt Simbrunner  1   2 , Laurenz Fritz  1 , Laurenz Hauptmann  4 , Mathias Jachs  1   2 , Julia Jedamzik  3 , Behrang Mozayani  5 , Lisa Gensthaler  3 , Daniel Moritz Felsenreich  3 , Mattias Mandorfer  1   2 , Felix Langer  3 , Michael Trauner  1 , Thomas Reiberger  1   2 , Gerhard Prager  3 , David Jm Bauer  1   6   2
Affiliations

UDFF and Auto pSWE accurately assess liver steatosis and fibrosis risk in obese patients with MASLD

Nina Dominik et al. Ultraschall Med. 2025 Dec.

Abstract
in English, German

Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to fibrosis and cirrhosis. Fibrosis and steatosis assessment with vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) requires a dedicated device and time to obtain ≥10 reliable measurements. Auto pSWE allows for the simultaneous collection of 15 ARFI-based liver stiffness measurements (LSM) and UDFF-based steatosis assessment in a single acquisition.This prospective study included patients undergoing liver biopsy, primarily during bariatric surgery, between 11/2021-12/2023. Paired LSM by Auto pSWE/VCTE and steatosis assessments by UDFF/CAP were performed within a median of 1 day before or after biopsy.134 patients (65% women, mean age: 42.6±13.3 years) with a high prevalence of obesity (mean BMI: 42.7±10.4; MASLD etiology: 88%) were included. Liver biopsy showed significant fibrosis (≥F2) in 27% of patients and moderate steatosis (≥S2) in 51%. A single 1×15 Auto pSWE acquisition and one UDFF measurement were as accurate as the median of 5 measurements. Auto pSWE (AUC: ≥F2=0.58, ≥F3=0.96, F4=0.97) and VCTE (AUC: ≥F2=0.60, ≥F3=0.92, F4=0.93) demonstrated high accuracy for advanced fibrosis stages. UDFF (AUC: ≥S1=0.79, ≥S2=0.78, S3=0.67) and CAP showed similar diagnostic accuracy.Auto pSWE and UDFF provide accurate, noninvasive tests for advanced liver fibrosis and steatosis in MASLD, even in severely obese patients. Notably, Auto pSWE captures 15 LSM with UDFF in a single acquisition, saving time and eliminating the need for a dedicated device.

Die mit Stoffwechselstörungen assoziierte steatotische Lebererkrankung (Metabolic dysfunction-associated steatotic liver disease; MASLD) kann zu Fibrose und Zirrhose führen. Die nicht-invasive Beurteilung von Fibrose und Steatose mittels vibrationskontrollierter transienter Elastografie (VCTE) und Controlled-Attenuation-Parameter-(CAP-)Technologie erfordert ein spezielles Gerät und mindestens 10 verlässliche Messungen. Die ultraschall-basierte Fettfraktion (UDFF) und die Auto-Punkt-Scherwelle (Auto-pSWE) ermöglichen eine Quantifizierung von Lebersteatose und -fibrose in nur einer Akquisition.Diese prospektive Studie umfasste Patient:innen, die zwischen 11/2021 und 12/2023 eine Leberbiopsie erhielten. Paarweise Lebersteifigkeits- und Steatosemessungen durch Auto pSWE/UDFF und VCTE/CAP wurden einen Tag vor oder nach der Leberbiopsie durchgeführt.134 Patient:innen mit hoher Adipositas-Prävalenz wurden eingeschlossen. Eine einzige Akquisition (welche 15 pSWE-Messungen erfasst) durch Auto-pSWE lieferte dieselbe diagnostische Genauigkeit wie der Median aus 5 Messungen. Auto-pSWE (≥F2, AUC=0,58; ≥F3, AUC=0,96; F4, AUC=0,97) und VCTE zeigten eine hohe diagnostische Genauigkeit für die Erfassung einer fortgeschrittenen Fibrose. Die Diagnosegenauigkeit von UDFF (≥S1, AUC=0,79; ≥S2, AUC=0,78) war vergleichbar mit CAP.Auto pSWE und UDFF sind präzise, nicht-invasive Methoden zur Diagnostik fortgeschrittener Leberfibrose und -steatose bei Patient:innen mit MASLD. Die simultane Erfassung von 15 pSWE-Messungen und UDFF in einer Akquisition ist zeitsparend und erfordert kein spezielles Gerät.

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Conflict of interest statement

The following authors declared no conflicts: N.D., L.N., M.S., B.H., Lu.H., Lo.H., L.F., J.J., L.G., F.B.L., and G.P. M.J. has served as a speaker and consultant for Gilead Sciences and has received travel support from the same company. G.S. received travel support from Gilead. B.Si. received travel support from both AbbVie and Gilead. L.B. received speaker fees from Chiesi and Gilead. M.T. received speaker fees from BMS, Falk Foundation, Gilead, Intercept, Janssen, Madrigal, MSD, and Roche. He has also served as an advisor for AbbVie, Albireo, BiomX, Boehringer Ingelheim, Cymabay, Falk Pharma GmbH, Genfit, Gilead, Hightide, Intercept, Janssen, MSD, Novartis, Phenex, Pliant, Rectify, Regulus, Siemens, and Shire. In addition, he received travel support from AbbVie, Falk, Gilead, Intercept, and Janssen, and research grants from Albireo, Alnylam, Cymabay, Falk, Gilead, Intercept, MSD, Takeda, and UltraGenyx. He is also a co-inventor on patents concerning the medical use of norUDCA, filed by the Medical Universities of Graz and Vienna. B.M. received a speaker fee from Astellas Pharma. M.M. served as a speaker, consultant, and/or advisory board member for AbbVie, Collective Acumen, Gilead, Takeda, and W. L. Gore & Associates, and received travel support from AbbVie and Gilead. T.R. received grant support from AbbVie, Boehringer Ingelheim, Gilead, Gore, Intercept, MSD, Myr Pharmaceuticals, Philips Healthcare, Pliant, and Siemens; speaker honoraria from AbbVie, Gilead, Gore, Intercept, Roche, and MSD; consulting/advisory board fees from AbbVie, Bayer, Boehringer Ingelheim, Gilead, Intercept, MSD, and Siemens; and travel support from AbbVie, Boehringer Ingelheim, Gilead, and Roche. D.B. received grant support from Gilead, travel support from Siemens, AbbVie, and Gilead, and speaker honoraria from AbbVie and Siemens.

Figures

Fig. 1
Fig. 1
Patient flowchart. Abbreviations: Auto pSWE: automated point shear wave elastography; CAP: controlled attenuation parameter; DAX: deep abdominal (transducer); PSVD: porto-sinusoidal vascular disorder; UDFF: ultrasound-derived fat fraction; VCTE: vibration-controlled transient elastography
Fig. 2
Fig. 2
Beeswarm/violin plots of ( A ) log-transformed Auto pSWE and ( B ) log-transformed reliable VCTE according to histological fibrosis stage, and ( C ) UDFF and ( D ) reliable CAP according to histological steatosis grade. Individual measurements are represented as points corresponding to the stage of fibrosis or grade of steatosis, with median values indicated by a solid black line. Abbreviations: Auto pSWE: automated point shear wave elastography; CAP: controlled attenuation parameter; UDFF: ultrasound-derived fat fraction; VCTE: vibration-controlled transient elastography
Fig. 3
Fig. 3
Scatter plots illustrating the correlation between ( A ) log-transformed reliable VCTE and log-transformed Auto pSWE and ( B ) reliable CAP and UDFF measurements. The Spearman correlation coefficients and the number of individuals included are displayed in the upper left corner. Abbreviations: Auto pSWE: automated point shear wave elastography; CAP: controlled attenuation parameter; UDFF: ultrasound-derived fat fraction; VCTE: vibration-controlled transient elastography
Fig. 4
Fig. 4
ROC curves for the detection of (≥F2) significant fibrosis, (≥F3) advanced fibrosis, (F4) cirrhosis for Auto pSWE and VCTE, as well as for the detection of (≥S1) mild steatosis, (≥S2) moderate steatosis, and (≥S3) severe steatosis for CAP and UDFF. The curves are presented with AUC with the corresponding 95% confidence intervals and p-values determined through bootstrapping (n=2000). Abbreviations: Auto pSWE: automated point shear wave elastography; CAP: controlled attenuation parameter; ROC: receiver operator characteristics; UDFF: ultrasound-derived fat fraction; VCTE: vibration-controlled transient elastography
See this image and copyright information in PMC

References

    1. Riazi K, Azhari H, Charette JH et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(09):851–861. doi: 10.1016/S2468-1253(22)00165-0. - DOI - PubMed
    1. Loomba R, Wong R, Fraysse J et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther. 2020;51(11):1149–1159. doi: 10.1111/apt.15679. - DOI - PubMed
    1. Castera L, Friedrich-Rust M, Loomba R. Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2019;156(05):1264–1281. doi: 10.1053/j.gastro.2018.12.036. - DOI - PMC - PubMed
    1. Semmler G, Wöran K, Scheiner B et al. Novel reliability criteria for controlled attenuation parameter assessments for non-invasive evaluation of hepatic steatosis. United European Gastroenterol J. 2020;8(03):321–331. doi: 10.1177/2050640619900820. - DOI - PMC - PubMed
    1. Kubale R, Schneider G, Lessenich CPN et al. Ultrasound-Derived Fat Fraction for Hepatic Steatosis Assessment: Prospective Study of Agreement With MRI PDFF and Sources of Variability in a Heterogeneous Population. AJR Am J Roentgenol. 2024;222(06):e2330775. - PubMed