We aimed to assess the feasibility of ultrasound-based tissue attenuation imaging
(TAI) and tissue scatter distribution imaging (TSI) for quantification of liver steatosis
in patients with nonalcoholic fatty liver disease (NAFLD). We prospectively enrolled
101 participants with suspected NAFLD. The TAI and TSI measurements of the liver were
performed with a Samsung RS85 Prestige ultrasound system. Based on the magnetic resonance
imaging proton density fat fraction (MRI-PDFF), patients were divided into ≤5%, 5-10%,
and ≥10% of MRI-PDFF groups. We determined the correlation between TAI, TSI, and MRI-PDFF
and used multiple linear regression analysis to identify any association with clinical
variables. The diagnostic performance of TAI, TSI was determined based on the area
under the receiver operating characteristic curve (AUC). The intraclass correlation
coefficient (ICC) was calculated to assess interobserver reliability. Both TAI (rs
= 0.78, P < .001) and TSI (rs = 0.68, P < .001) showed significant correlation with
MRI-PDFF. TAI overperformed TSI in the detection of both ≥5% MRI-PDFF (AUC = 0.89
vs 0.87) and ≥10% (AUC = 0.93 vs 0.86). MRI-PDFF proved to be an independent predictor
of TAI (β = 1.03; P < .001), while both MRI-PDFF (β = 50.9; P < .001) and liver stiffness
(β = -0.86; P < .001) were independent predictors of TSI. Interobserver analysis showed
excellent reproducibility of TAI (ICC = 0.95) and moderate reproducibility of TSI
(ICC = 0.73). TAI and TSI could be used successfully to diagnose and estimate the
severity of hepatic steatosis in routine clinical practice.
