ArticleQuantitative imaging in medicine and surgery2026
Accurate and spatially stable quantification of hepatic steatosis using ultrasound-derived fat fraction in metabolic dysfunction-associated steatotic liver disease (MASLD): a prospective magnetic resonance imaging-proton density fat fraction (MRI-PDFF) study.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Accurate and noninvasive quantification of hepatic steatosis is essential for managing metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated the diagnostic accuracy, spatial stability, and clinical correlates of ultrasound-derived fat fraction (UDFF) in MASLD patients. Methods: In this prospective study of an Asian population, we enrolled 109 patients with MASLD and 20 healthy controls. UDFF was measured across hepatic segments V-VIII, with the mean value (UDFF mean) calculated. Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) served as the reference standard. Diagnostic performance, agreement, and determinants were assessed using receiver operating characteristic (ROC) curves, Bland-Altman analysis, and multivariable regression. Results: UDFF mean increased stepwise with MRI-PDFF-defined steatosis grades (P<0.0001). The areas under the curve (AUCs) for detecting ≥S1, ≥S2, and S3 steatosis were 1.00, 0.99, and 0.99, respectively. Optimal cut-off values were 5.09%, 11.18%, and 18.46%. UDFF demonstrated excellent reproducibility with an intraclass correlation coefficient (ICC) of 0.98 and showed no significant systematic bias on Bland-Altman analysis. Alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), age, and sex were independently associated with UDFF (all P<0.05). Conclusions: UDFF provides a stable and accurate ultrasound-based assessment of hepatic fat burden in MASLD, with excellent agreement with MRI-PDFF and high spatial reproducibility, supporting its clinical utility for noninvasive risk stratification and longitudinal monitoring.
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