Comparison of three ultrasound-based techniques for diagnosing hepatic steatosis in overweight people

doi:10.3877/cma.j.issn.1672-6448.2025.07.003

Abstract

Abstract:

Objective

To make a prospective comparison of US-guided attenuation parameter (UGAP), ultrasound attenuation parameter (UAP), and semi-quantitative assessment based on two-dimensional ultrasound for the diagnosis of hepatic steatosis in overweight population suspected of having metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

One hundred and three overweight patients who underwent standardized clinical assessment, abdominal ultrasound (UGAP, UAP, and semi-quantitative assessment based on two-dimensional ultrasound), and magnetic resonance imaging-proton density fat fraction (MRI-PDFF) were enrolled in this prospective study from December 2023 to March 2024. The correlation between UAP, UGAP, and MRI-PDFF was evaluated using Pearson's correlation coefficient. The receiver operating characteristic (ROC) curves of two-dimensional ultrasound, UAP, and UGAP were compared, and using MRI-PDFF as a reference, hepatic steatosis was classified into grades S0, S1, S2 and S3. Multivariable linear regression was performed to identify independent factors associated with UGAP and UAP.

Results

Both UGAP and UAP were positively correlated with MRI-PDFF. UGAP had the most significant correlation with PDFF (r=0.852, P<0.001). The diagnostic performance of UGAP for different grades of hepatic steatosis was better than that of UAP and two-dimensional ultrasound (P<0.05). The UAP and two-dimensional ultrasound were not statistically significantly different with regard to the AUCs for different grades of steatosis. The AUCs of UGAP for the diagnosis of hepatic steatosis ≥S1, ≥S2, and =S3 were 0.964 (95%CI: 0.931-0.997), 0.920 (95%CI: 0.856-0.984), and 0.970 (95%CI: 0.912-1.000), respectively. And the cut-off values for ≥S1, ≥S2, and =S3 were 0.60 dB/(cm·MHz), 0.72 dB/(cm·MHz), and 0.79 dB/(cm·MHz), respectively. Visceral fat and skin-to-liver capsule distance were independent factors for UAP and UGAP.

Conclusion

The diagnostic accuracy of UGAP is superior to that of UAP and two-dimensional ultrasound for the diagnosis and grading of hepatic steatosis in overweight subjects suspected of having MASLD.

Key words: Ultrasound, Metabolic dysfunction-associated steatotic liver disease, Hepatic steatosis, Overweight

Ruixia Gao, Jiahao Han, Danlei Song, Pingping Wang, Jia Li. Comparison of three ultrasound-based techniques for diagnosing hepatic steatosis in overweight people[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(07): 600-607.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2025.07.003

https://chaosheng.cma-cmc.com.cn/EN/Y2025/V22/I07/600

Figures/Tables 6

项目	数值
男性/女性（例）	63/40
年龄[岁，M（Q₁，Q₃）]	46.0（36.0，57.3）
腰围[cm，M（Q₁，Q₃）]	92.00（88.00，102.00）
内脏脂肪（cm²， $x ¯ ± s$ ）	101.09±41.69
SCD[mm，M（Q₁，Q₃）]	18.85（16.67，20.20）
BMI[kg/m²，M（Q₁，Q₃）]	27.25（25.44，31.00）
空腹血糖[mmol/L，M（Q₁，Q₃）]	5.99（5.09，10.21）
HbA1c[%，M（Q₁，Q₃）]	6.13（5.34，7.73）
白蛋白[g/L，M（Q₁，Q₃）]	43.95（41.07，48.00）
总胆红素[μmol/L，M（Q₁，Q₃）]	9.85（7.30，12.35）
ALT[U/L，M（Q₁，Q₃）]	20.50（13.75，35.00）
AST[U/L，M（Q₁，Q₃）]	20.00（16.75，27.25）
GGT[U/L，M（Q₁，Q₃）]	31.00（19.75，44.00）
甘油三酯[mmol/L，M（Q₁，Q₃）]	1.68（1.23，3.79）
总胆固醇[mmol/L，M（Q₁，Q₃）]	4.93（4.11，5.70）
HDL-C[mmol/L，M（Q₁，Q₃）]	1.21（0.89，1.55）
LDL-C[mmol/L，M（Q₁，Q₃）]	2.64（1.85，3.04）
UAP（dB/m， $x ¯ ± s$ ）	281.0±40.0
UGAP[dB/（cm·MHz）， $x ¯ ± s$ ]	0.69±0.13
基于二维超声的肝脏脂肪变性定性分级[例（%）]
0级	28（27.2）
1级	36（35.0）
2级	18（17.5）
3级	21（20.4）
MRI-PDFF（%， $x ¯ ± s$ ）	14.13±8.47
基于MRI-PDFF^a的肝脏脂肪变性分级[例（%）]
S0	32（31.1）
S1	35（34.0）
S2	19（18.4）
S3	17（16.5）

项目	数值
男性/女性（例）	63/40
年龄[岁，M（Q₁，Q₃）]	46.0（36.0，57.3）
腰围[cm，M（Q₁，Q₃）]	92.00（88.00，102.00）
内脏脂肪（cm²， $x ¯ ± s$ ）	101.09±41.69
SCD[mm，M（Q₁，Q₃）]	18.85（16.67，20.20）
BMI[kg/m²，M（Q₁，Q₃）]	27.25（25.44，31.00）
空腹血糖[mmol/L，M（Q₁，Q₃）]	5.99（5.09，10.21）
HbA1c[%，M（Q₁，Q₃）]	6.13（5.34，7.73）
白蛋白[g/L，M（Q₁，Q₃）]	43.95（41.07，48.00）
总胆红素[μmol/L，M（Q₁，Q₃）]	9.85（7.30，12.35）
ALT[U/L，M（Q₁，Q₃）]	20.50（13.75，35.00）
AST[U/L，M（Q₁，Q₃）]	20.00（16.75，27.25）
GGT[U/L，M（Q₁，Q₃）]	31.00（19.75，44.00）
甘油三酯[mmol/L，M（Q₁，Q₃）]	1.68（1.23，3.79）
总胆固醇[mmol/L，M（Q₁，Q₃）]	4.93（4.11，5.70）
HDL-C[mmol/L，M（Q₁，Q₃）]	1.21（0.89，1.55）
LDL-C[mmol/L，M（Q₁，Q₃）]	2.64（1.85，3.04）
UAP（dB/m， $x ¯ ± s$ ）	281.0±40.0
UGAP[dB/（cm·MHz）， $x ¯ ± s$ ]	0.69±0.13
基于二维超声的肝脏脂肪变性定性分级[例（%）]
0级	28（27.2）
1级	36（35.0）
2级	18（17.5）
3级	21（20.4）
MRI-PDFF（%， $x ¯ ± s$ ）	14.13±8.47
基于MRI-PDFF^a的肝脏脂肪变性分级[例（%）]
S0	32（31.1）
S1	35（34.0）
S2	19（18.4）
S3	17（16.5）

诊断方法	AUC（95%CI）	截断值	敏感度（%）	特异度（%）	阳性预测值（%）	阴性预测值（%）
UGAP[dB/（cm·MHz）]
≥S1	0.964（0.931，0.997）	0.60	97.2	96.9	98.57	93.94
≥S2	0.920（0.856，0.984）	0.72	91.7	85.1	74.36	89.06
S3	0.970（0.912，1.000）	0.79	100	99.3	71.43	97.56
UAP（dB/m）
≥S1	0.881（0.817，0.944）^a	274.5	77.5	93.7	82.14	45.65
≥S2	0.864（0.782，0.946）	294.0	83.3	85.1	64.10	82.81
S3	0.852（0.734，0.970）^c	306.5	76.5	84.9	52.38	92.68
二维超声
≥S1	0.829（0.751，0.907）^a	-	90.1	65.6	85.33	75.00
≥S2	0.803（0.708，0.899）^b	-	69.4	79.1	64.10	82.81
S3	0.823（0.696，0.949）^c	-	64.7	88.4	52.38	92.68

参数	OR（95%CI）	P值
性别	29.03（0.53，59.01）	0.099
年龄	1.03（0.91，1.17）	0.606
腰围	1.19（0.91，1.55）	0.195
内脏脂肪	1.00（0.94，1.08）	0.870
SCD	1.15（0.59，2.27）	0.678
BMI	1.20（0.43，3.38）	0.724
二维超声	5.10（0.61，42.52）	0.132
UAP	1.00（0.96，1.05）	0.957
UGAP	9.08（6.46，12.76）	0.005

参数	UAP		UGAP
参数	相关系数	P值	相关系数	P值
年龄	0.019	0.85	0.018	0.856
腰围	0.663	<0.001	0.602	<0.001
内脏脂肪	0.658	<0.001	0.558	<0.001
SCD	0.479	<0.001	0.501	<0.001
BMI	0.608	<0.001	0.484	<0.001
空腹血糖	0.324	<0.001	0.571	<0.001
HbA1c	0.337	<0.001	0.39	<0.001
白蛋白	0.36	<0.001	0.283	0.004
总胆红素	0.072	0.468	-0.003	0.975
ALT	0.464	<0.001	0.569	<0.001
AST	0.54	<0.001	0.583	<0.001
GGT	0.39	<0.001	0.302	0.002
甘油三酯	0.527	<0.001	0.683	<0.001
总胆固醇	-0.025	0.801	-0.041	0.679
HDL-C	-0.137	0.168	-0.045	0.650
LDL-C	-0.009	0.929	-0.113	0.256

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