Noninvasive assessment of hepatic steatosis using a pathologic reference standard: comparison of CT, MRI, and US-based techniques

• Published in: Ultrasonography (Seoul, Korea) Vol. 41; no. 2; pp. 344 - 354
• Main Authors: Bae, Jae Seok, Lee, Dong Ho, Suh, Kyung-Suk, Kim, Haeryoung, Lee, Kyung Bun, Lee, Jae Young, Han, Joon Koo
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Ultrasound in Medicine 01.04.2022
• Subjects: Clinical trials; diagnostic imaging; fatty liver; Liver diseases; Magnetic resonance imaging; nonalcoholic fatty liver disease; Original; United States > US; Diagnostic imaging; Nonalcoholic fatty liver disease; Fatty liver
• ISSN: 2288-5919; 2288-5943
• DOI: 10.14366/usg.21150

Purpose: The present study compared the performance of computed tomography (CT), magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF), controlled attenuation parameter (CAP), grayscale ultrasonography (US), and attenuation imaging (ATI) for the diagnosis of hepatic steatosis (HS).Methods: In total, 120 prospectively recruited patients who underwent hepatic resection between June 2018 and June 2020 were retrospectively analyzed. CT, MRI-PDFF, CAP, grayscale US, and ATI were performed within 3 months before surgery. Diagnostic performance for HS ≥5% and HS >33% was compared using the area under the curve (AUC) of receiver operating characteristic curves. Histopathologic examinations served as the reference standard for the degree of HS.Results: For detecting HS ≥5%, MRI-PDFF (AUC, 0.946) significantly outperformed CT, CAP and grayscale US (AUC, 0.807, 0.829, and 0.761, respectively) (P<0.01 for all). ATI (AUC, 0.892) was the second-best modality and significantly outperformed grayscale US (P=0.001). In pairwise comparisons, there were no significant differences between the AUC of ATI and the values of MRI-PDFF, CT, or CAP (P=0.133, P=0.063, and P=0.150, respectively). For detecting HS >33%, all the modalities provided good diagnostic performance without significant differences (AUC, 0.887-0.947; P>0.05 for all).Conclusion: For detecting HS ≥5%, MRI-PDFF was the best imaging modality, while ATI outperformed grayscale US. For detecting HS >33%, all five imaging tools demonstrated good diagnostic performance.