Diagnostic Effectiveness of Hepatic Fat Quantification Using Ultrasound-Based Acoustic Attenuation Index to Grade Severity of Hepatic Steatosis in an Asian Indian Population

Abstract

Aim The aim of the study is to determine the diagnostic effectiveness of liver fat quantification using ultrasound-based acoustic attenuation imaging (ATI) to grade the severity of hepatic steatosis in an Asian Indian population. Methods A diagnostic center-based cross-sectional study was conducted, adhering to the Standards for Reporting of Diagnostic Accuracy Studies guidelines for diagnostic effectiveness studies. Participants underwent ATI and magnetic resonance imaging proton density fat fraction (MRI-PDFF) assessments. The area under the receiver operating characteristic curve (AUROC) was used to determine cutoff values to differentiate grades of hepatic steatosis based on ATI. The diagnostic effectiveness of ATI using MRI-PDFF as the gold standard and its correlation with MRI-PDFF was ascertained. Results The study included 131 participants with a mean age of 48.68 ± 12.05 years; 61.07% were males. The ATI for Grade 0 (normal) steatosis was <0.67 dB/cm/MHz, ≥0.67 to <0.83 for grade 1 (mild steatosis), ≥0.83 to <0.93 for grade 2 (moderate steatosis), and ≥0.93 for grade 3 (severe steatosis). The ATI cutoff of 0.67 dB/cm/MHz had good sensitivity (77.9%), specificity (92.6%) and AUROC (0.85) to differentiate hepatic steatosis. ATI had a correlation of 0.66 with MRI-PDFF in this study. Conclusion ATI has good diagnostic effectiveness for differentiating hepatic steatosis in this population and can be used as a first-line imaging strategy in preventive radiology clinics in India.