Quantitative assessment of fatty liver using ultrasound attenuation imaging

Ultrasound-guided attenuation parameter: a liver fat quantification technique for forecasting the progression of metabolic dysfunction-associated steatotic liver disease in overweight/obese patients

AIM

To investigate the application value of ultrasonic attenuation parameter imaging (UGAP) in the assessment of metabolic dysfunction-associated steatotic liver disease (MASLD) in overweight and obese patients.

MATERIAL AND METHODS

A total of 328 overweight/obese patients-225 in the MASLD group and 103 in the simple overweight/obese group-were chosen from XX between August 2023 and August 2024. As the typical control group, 236 healthy individuals who were matched for age and gender were chosen during the same period. The attenuation coefficient (AC) differences between the groups were compared, and Pearson correlation analysis was used to look into the relationship between AC and clinical indicators. A prediction model was created, the diagnostic efficacy was examined, and MASLD risk factors in overweight and obese patients were screened using the independent sample T-test and multiple logistic regression analysis.

RESULTS

AC of the MASLD group, overweight and obese group, and normal control group were (0.73 ± 0.08), (0.57 ± 0.04), and (0.54 ± 0.07) dB-1·cm-1·MHz-1. There was a statistically significant difference between the groups (P<0.05). In patients who were overweight or obese, AC, BMI, and visceral fat were the risk factors for predicting MASLD. The optimal cut-off values were AC ≥0.635dB-1·cm-1·MHz-1, BMI ≥27.58kg/m2, and visceral fat thickness (VFT) ≥66.115 mm. The areas under the receiver operating characteristic (ROC) curve were 0.993, 0.792, and 0.708. The area under ROC curve of AC combined with BMI and visceral fat was 0.997, and the prediction efficiency was greater than that of the single AC index and that of the AC + BMI bivariate prediction model. The diagnostic sensitivity and specificity were 96.4% and 98.1%.

CONCLUSION

UGAP can be utilised for clinical screening to assess the prevalence of MASLD in patients who are overweight or obese and to dynamically track the progression of the disease. In patients who are overweight or obese, the accuracy of the UGAP assessment of MASLD can be increased by combining AC with BMI and a visceral fat prediction model.

Application of Two-Dimensional Shear Wave Elastography in Evaluating Liver Reserve Function in Patients With Liver Cancer

BACKGROUND

Shear wave elastography (SWE) is an emerging noninvasive imaging technique for assessing liver fibrosis. This meta-analysis aimed to evaluate the diagnostic accuracy of SWE compared to conventional imaging techniques.

METHODS

A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases. Nine studies were included, and diagnostic performance metrics, including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC), were pooled using meta-analysis. Publication bias was assessed using Deeks' funnel plot asymmetry test.

RESULTS

The pooled sensitivity and specificity of SWE were 0.88 (95% CI: 0.83-0.92) and 0.88 (95% CI: 0.83-0.91), respectively. The positive likelihood ratio (PLR) was 7.07 (95% CI: 5.26-9.50), and the negative likelihood ratio (NLR) was 0.14 (95% CI: 0.09-0.20). The DOR was 51.85 (95% CI: 29.80-90.19), and the area under the SROC curve (AUC) was 0.94 (95% CI: 0.91-0.96), indicating excellent diagnostic accuracy. Fagan nomogram analysis further confirmed SWE's clinical utility by significantly improving post-test probability. No significant publication bias was detected (p = 0.26).

CONCLUSION

SWE is a highly accurate and reliable tool for diagnosing liver fibrosis, demonstrating superior diagnostic performance compared to conventional imaging techniques. SWE has significant potential to serve as a noninvasive alternative to liver biopsy in the clinical assessment of liver fibrosis.

Preliminary study on determining the optimal position of region of interest for evaluating hepatic steatosis using ultrasound Attenuation imaging

PURPOSE

To find the optimal position of region of interest (ROI) for evaluating hepatic steatosis using attenuation imaging (ATI) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).

METHODS

We retrospectively enrolled 143 consecutive patients who underwent percutaneous liver biopsy for the evaluation of MAFLD between October 2020 and October 2022. All ATI measurements were performed by the same radiologist. The ATI-ROI was placed at four different positions using a specialized workstation: the top edge of the sampling box (P1), the lower edge of the dark orange region (P2), 0.5 cm and 1 cm below the lower edge of the dark orange region (P3 and P4). Multivariate linear regression analysis and the area under the curve (AUC) analysis were performed.

RESULTS

The AUCs of ATI at the four different ATI-ROI positions were 0.472 (95% confidence interval [CI]: 0.362-0.581), 0.693(0.611-0.768), 0.757(0.611-0.768), and 0.809 (0.735-0.870) for ≥ S1; 0.544 (0.459-0.628), 0.779 (0.702-0.844), 0.842 (0.772-0.898), and 0.865 (0.798-0.916) for ≥ S2; and 0.655 (0.571-0.733), 0.904 (0.843-0.947), 0.95 (0.9-0.979), and 0.949 (0.9-0.979) for S3, respectively. The factor that most significantly affected ATI was steatosis grade(P<0.001), when ATI-ROI was placed at the position of P2, P3, and P4.

CONCLUSION

Hepatic steatosis grade was the most significant determinant factor for ATI value at multivariate analysis. When clinicians conduct ATI measurement, the dark orange region indicating the area of reverberation artifact should be avoided, and placing the ATI-ROI 1 cm below the lower edge of the dark orange region may be a better choice.

PBCS-ConvNeXt: Convolutional Network-Based Automatic Diagnosis of Non-alcoholic Fatty Liver in Abdominal Ultrasound Images

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver condition characterized by excessive hepatic fat accumulation. Early diagnosis is crucial as NAFLD can progress to more severe conditions like steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma without timely intervention. While liver biopsy remains the gold standard for NAFLD assessment, abdominal ultrasound (US) imaging has emerged as a widely adopted non-invasive modality due to convenience and low cost. However, the subjective interpretation of US images is challenging and unpredictable. This study proposes a deep learning-based computer-aided diagnosis (CAD) model, termed potent boosts channel-aware separable intent - ConvNeXt (PBCS-ConvNeXt), for automated NAFLD classification using B-mode US images. The model architecture comprises three key components: The potent stem cell, an advanced trainable preprocessing module for robust feature extraction; Enhanced ConvNeXt Blocks that amplify channel-wise features to refine processing; and the boosting block that integrates multi-stage features for effective information extraction from US data. Utilizing fatty liver gradings from attenuation imaging (ATI) as the ground truth, the PBCS-ConvNeXt model was evaluated using 5-fold cross-validation, achieving an accuracy of 82%, sensitivity of 81% and specificity of 83% for identifying fatty liver on abdominal US. The proposed CAD system demonstrates high diagnostic performance in NAFLD classification from US images, enabling early detection and informing timely clinical management to prevent disease progression.

The growing range of complications of diabetes mellitus

With the rising prevalence of type 2 diabetes mellitus (T2DM) and obesity, several previously under-recognised complications associated with T2DM are becoming more evident. The most common of these emerging complications are metabolic dysfunction-associated steatotic liver disease (MASLD), cancer, dementia, sarcopenia, and frailty, as well as other conditions involving the lung, heart, and intestinal tract. Likely causative factors are chronic inflammation and insulin resistance, whereas blood glucose levels appear to play a lesser role. We discuss these complications and the new approaches being developed to prevent and manage them, especially incretin-based therapies. We argue that these new interventions may work in a complementary way to other proven cardiorenal protective therapies to reduce the burden of T2DM complications.

Enhancing deep-seated hepatocellular carcinoma detection: assessing the added value of high mechanical index setting in sonazoid-based contrast-enhanced ultrasound during post-vascular phase

PURPOSE

This retrospective study aimed to investigate the role of an additional high mechanical index (MI) setting scan during the post-vascular phase (PVP) in detecting deep-seated hepatocellular carcinoma (HCC) lesions.

METHODS

A total of 805 confirmed HCCs, which underwent Sonazoid-based contrast-enhanced ultrasound (CEUS) between January 2014 and October 2021, were included. Low MI scan was initially employed for lesion detection during the PVP, followed by high MI scan. Propensity score matching (PSM) was utilized to address confounding variables.

RESULTS

Of the 805 study lesions, 668 were detected as perfusion defects at the initial low MI setting, while 137 remained undetected. Among these 137 undetected lesions, 77 were identified at the subsequent high MI setting, whereas 60 remained undetected. Lesions that were larger (18.69 ± 11.27 mm vs. 16.55 ± 7.42 mm, p = 0.006), more superficial (6.06 ± 2.41 cm vs. 7.40 ± 2.74 cm, p < 0.001), and hypoechoic (482/668 vs. 62/137, p < 0.001) were detectable at the initial low MI setting. Male patients benefited more from the additional high MI scan (63/97 vs. 14/40, p < 0.001). Lesions identified with additional high MI were larger (18.30 ± 8.76 mm vs. 14.30 ± 4.34 mm, p < 0.001) and deeper than undetected ones (8.48 ± 2.48 cm vs. 6.02 ± 2.43 cm, p < 0.001). After PSM, depth was shown to be an independent predictor in multivariate analysis (odds ratio: 1.557, 95% confidence interval: 1.249-1.941). The depth cutoff was 7.75 cm, with a sensitivity of 0.681, specificity of 0.851, and area under the curve of 0.774.

CONCLUSIONS

The additional high MI setting scan during the PVP of Sonazoid-based CEUS leads to enhanced detection of deep-seated HCCs.

Ethnic Minority Disparities in the Epidemiology of Metabolic Dysfunction-Associated Steatotic Liver Disease in a Representative Area of China

OBJECTIVE

We aimed to evaluate the differences in clinical features and lifestyle between Han and ethnic minority populations in Guangdong Province, China and their impacts on the ever-growing burden of metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

In this cross-sectional investigation in Guangdong Province, China, one of the most densely populated areas with imbalanced development, multistage stratified random sampling was used. Demographic, socioeconomic, and lifestyle data of participants were collected. Assessment of hepatic steatosis and liver stiffness measurement were performed.

RESULTS

A total of 7287 individuals were recruited, including 7076 Han and 211 ethnic minority individuals, with similar MASLD prevalence between the two groups (35.8% vs 34.6%, p = 0.771). More ethnic minority individuals presented advanced fibrosis (≥ F3) overall and in subgroups of overweight/obesity, lean/normal weight, and males, but less advanced fibrosis in females and age of 30-34 years (all p < 0.05) than the Han Chinese. Proper physical activity was associated with a reduced risk of MASLD (Han: odds ratio [OR] 0.64, p = 0.021; ethnic minority: OR 0.06, p = 0.017). Sufficient sleep, drinking tea, and dietary fiber intake were protective factors for MASLD, while long sedentary duration, midnight snacks, dining out, and excessive intake of salt, red meat, and sugar were associated with a higher risk of MASLD in Han Chinese only.

CONCLUSIONS

There was a strikingly high burden of MASLD in the ethnic minority in Guangdong Province, China, and their lifestyle differences compared with Han Chinese may contribute to the epidemic surge of MASLD.

Diagnostic performance of quantitative ultrasonography for hepatic steatosis in a health screening program: a prospective single-center study

PURPOSE

This study compared the diagnostic performance of quantitative ultrasonography (QUS) with that of conventional ultrasonography (US) in assessing hepatic steatosis among individuals undergoing health screening using magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) as the reference standard.

METHODS

This single-center prospective study enrolled 427 participants who underwent abdominal MRI and US. Measurements included the attenuation coefficient in tissue attenuation imaging (TAI) and the scatter-distribution coefficient in tissue scatter-distribution imaging (TSI). The correlation between QUS and MRI-PDFF was evaluated. The diagnostic capabilities of QUS, conventional B-mode US, and their combined models for detecting hepatic fat content of ≥5% (MRI-PDFF ≥5%) and ≥10% (MRI-PDFF ≥10%) were compared by analyzing the areas under the receiver operating characteristic curves. Additionally, clinical risk factors influencing the diagnostic performance of QUS were identified using multivariate linear regression analyses.

RESULTS

TAI and TSI were strongly correlated with MRI-PDFF (r=0.759 and r=0.802, respectively; both P<0.001) and demonstrated good diagnostic performance in detecting and grading hepatic steatosis. The combination of QUS and B-mode US resulted in the highest areas under the ROC curve (AUCs) (0.947 and 0.975 for detecting hepatic fat content of ≥5% and ≥10%, respectively; both P<0.05), compared to TAI, TSI, or B-mode US alone (AUCs: 0.887, 0.910, 0.878 for ≥5% and 0.951, 0.922, 0.875 for ≥10%, respectively). The independent determinants of QUS included skinliver capsule distance (β=7.134), hepatic fibrosis (β=4.808), alanine aminotransferase (β=0.202), triglyceride levels (β=0.027), and diabetes mellitus (β=3.710).

CONCLUSION

QUS is a useful and effective screening tool for detecting and grading hepatic steatosis during health checkups.

Diagnostic Performance of Quantitative Ultrasound Parameters in Non-alcoholic Fatty Liver Disease

RATIONALE AND OBJECTIVES

Marked liver steatosis, steatohepatitis, and significant fibrosis are risk factors for unfavorable outcomes in non-alcoholic fatty liver disease (NAFLD). In this study, the diagnostic performance of attenuation coefficient (AC), liver stiffness (LS), and dispersion slope (DS) was evaluated separately and combined in the diagnosis of liver steatosis and fibrosis in NAFLD suspects using biopsy or magnetic resonance imaging (MRI) as a reference standard.

MATERIALS AND METHODS

Seventy-four NAFLD suspects were prospectively imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). AC, LS, and DS measurements were obtained from the right liver lobe.

RESULTS

Thirty-four patients underwent liver biopsy, and 40 had MRI. There were 32 patients (43%) with liver steatosis and fibrosis (S + F), 22 (30%) with steatosis (S), 5 (7%) with fibrosis (F), and 15 (20%) with normal liver (N). Mean ACs were significantly higher in steatotic livers (n = 54) than in non-steatotic livers (n = 20) (P < 0.0001). LS and DS were significantly higher in patients with liver fibrosis (n = 37) compared to non-fibrotic livers (n = 37) (P = 0.0004 and P = 0.0002, respectively). In detecting (S + F), the area under the receiver operating characteristic curve (AUROCC) was 0.87 for combined ultrasound parameters of LS and AC (negative predictive value [NPV]: 75%, positive predictive value [PPV]: 77%, P < 0.0001). In detecting patients with liver steatosis and fibrosis stage ≥2, LS had an AUROCC of 0.93 (NPV: 87%, PPV: 82%, P < 0.0001). In the biopsy group, 32% (11/34) were diagnosed with non-alcoholic steatohepatitis (NASH). DS values showed a significant difference among patients with (n = 23) or without (n = 11) hepatocellular ballooning (P = 0.02). AUROCC was 0.87 for combined ultrasound parameters of AC, LS, and DS with body mass index (BMI) in detecting NASH (NPV: 80%, PPV: 87%, P = 0.0006).

CONCLUSION

AC and LS showed high diagnostic value in detecting liver steatosis and fibrosis, respectively. The combined AC and LS values further improved the diagnostic accuracy in detecting NAFLD and high-risk NAFLD patients.

Ultrasound Attenuation Imaging vs MRI-PDFF, Echogenicity and Liver Function for Assessing Degree of Steatosis in NAFLD and Non-NAFLD Patients

ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is a primary cause of parenchymal liver disease globally. There are currently several methods available to test the degree of steatosis in NAFLD patients, but all have drawbacks that limit their use.The objective of this study is to determine if a new technique, ultrasound (US) attenuation imaging (ATI), correlates with magnetic resonance proton density fat fraction imaging and hepatic echogenicity as seen on gray scale US imaging.Fifty-four patients were recruited at the University of Washington Medical Center from individuals who had already been scheduled for hepatic US or magnetic resonance imaging (MRI). All participants then underwent both hepatic MRI proton density fat fraction and US. Ultrasound images were then evaluated using ATI with 2 observers who individually determined relative grayscale echogenicity.Analysis showed positive correlation between ATI- and MRI-determined fat percentage in the case group (Spearman correlation: 0.50; P = 0.015). Furthermore, participants with NAFLD tended to have a higher ATI than controls (median: 0.70 vs 0.54 dB/cm/MHz; P < 0.001).This study demonstrates that US ATI combined with grayscale imaging is an effective way of assessing the degree of steatosis in patients with moderate to severe NAFLD.

Quantitative Diagnosis of Nonalcoholic Fatty Liver Disease with Ultrasound Attenuation Imaging in a Biopsy-Proven Cohort

RATIONALE AND OBJECTIVES

To evaluate the performance of attenuation imaging (ATI) based on ultrasound for detection of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD).

MATERIALS AND METHODS

This prospective study was approved by our institutional review board (B2021-092R). Written informed consent was obtained from all patients. This study included 60 patients who had clinical suspicion of NAFLD and were referred for liver biopsy after ATI and controlled attenuation parameter (CAP) examinations between September 2020 and December 2021. The histologic hepatic steatosis was graded. The area under curve (AUC) analysis was performed.

RESULTS

The success rate of the ATI examination was 100%. The intraobserver reproducibility of ATI was 0.981. The AUCs of ATI for detecting ≥S1, ≥S2, and S3 were 0.968 (cut-off value of 0.671 dB/cm/MHz), 0.911 (cut-off value of 0.726 dB/cm/MHz), and 0.766 (cut-off value of 0.757 dB/cm/MHz), respectively. The AUCs of CAP for detecting ≥S1, ≥S2, and S3 were 0.916 (cut-off value of 258.5 dB/m), 0.872 (cut-off value of 300.0 dB/m), and 0.807 (cut-off value of 315.0 dB/m), respectively. The diagnostic values showed no significant difference between ATI and CAP in detecting ≥S1, ≥S2, and S3 (P = .281, P = .254, and P = .330, respectively). The ATI had significant correlations with high-density lipoprotein cholesterol (P < .001), and with triglycerides (P = .015).

CONCLUSION

ATI showed good feasibility and diagnostic performance in the detection of varying degrees of hepatic steatosis in NAFLD patients.

Non-invasive evaluation of liver steatosis with imaging modalities: New techniques and applications

In the world, nonalcoholic fatty liver disease (NAFLD) accounts for majority of diffuse hepatic diseases. Notably, substantial liver fat accumulation can trigger and accelerate hepatic fibrosis, thus contributing to disease progression. Moreover, the presence of NAFLD not only puts adverse influences for liver but is also associated with an increased risk of type 2 diabetes and cardiovascular diseases. Therefore, early detection and quantified measurement of hepatic fat content are of great importance. Liver biopsy is currently the most accurate method for the evaluation of hepatic steatosis. However, liver biopsy has several limitations, namely, its invasiveness, sampling error, high cost and moderate intraobserver and interobserver reproducibility. Recently, various quantitative imaging techniques have been developed for the diagnosis and quantified measurement of hepatic fat content, including ultrasound- or magnetic resonance-based methods. These quantitative imaging techniques can provide objective continuous metrics associated with liver fat content and be recorded for comparison when patients receive check-ups to evaluate changes in liver fat content, which is useful for longitudinal follow-up. In this review, we introduce several imaging techniques and describe their diagnostic performance for the diagnosis and quantified measurement of hepatic fat content.

Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal

The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations to their routine use in the detection and quantification of liver steatosis. Therefore, there has been a rising necessity for the development of new inexpensive, widely applicable and reliable non-invasive diagnostic tools. The controlled attenuation parameter has been considered the point-of-care technique for the assessment of liver steatosis for a long period of time. Recently, many ultrasound (US) system manufacturers have developed proprietary software solutions for the quantification of liver steatosis. Some of these methods have already been extensively tested with very good performance results reported, while others are still under evaluation. This manuscript reviews the currently available US-based methods for diagnosing and grading liver steatosis, including their classification and performance results, with an appraisal of the importance of this armamentarium in daily clinical practice.

Feasibility of Ultrasound Attenuation Imaging for Assessing Pediatric Hepatic Steatosis

We investigated the feasibility of ultrasound attenuation imaging (ATI) for assessing pediatric hepatic steatosis. A total of 111 children and adolescents who underwent liver ultrasonography with ATI for suspected hepatic steatosis were included. Participants were classified into the normal, mild, or moderate−severe fatty liver group according to grayscale US findings. Associations between clinical factors, magnetic resonance imaging proton density fat fraction, steatosis stage and ATI values were evaluated. To determine the cutoff values of ATI for staging hepatic steatosis, areas under the curve (AUCs) were analyzed. Factors that could cause measurement failure with ATI were assessed. Of 111 participants, 88 had successful measurement results. Median ATI values were significantly increased according to steatosis stage (p < 0.001). Body mass index (BMI) was a significant factor for increased ATI values (p = 0.047). To differentiate fatty liver from normal liver, a cutoff value of 0.59 dB/cm/MHz could be used with an AUC value of 0.853. To differentiate moderate to severe fatty liver from mild fatty liver, a cutoff value of 0.69 dB/cm/MHz could be used with an AUC value up to 0.91. ATI can be used in children as an effective ultrasonography technique for quantifying and staging pediatric hepatic steatosis.

Relationship Between Greyscale Ultrasound Grading of Hepatic Steatosis and Attenuation Imaging

Background

Non-alcoholic fatty liver disease (NAFLD) has been rising worldwide due to the rising public health threat of metabolic syndrome. Because non-alcoholic steatohepatitis can proceed to liver fibrosis and cirrhosis, early identification and monitoring are critical for management. For the examination of NAFLD, greyscale ultrasound has been frequently employed. A relatively new technique, attenuation imaging (ATI), can quantitatively evaluate and compute the attenuation coefficient (AC). Our goal was to evaluate the performance and cutoff values of attenuation imaging to identify hepatic steatosis. As a reference standard, greyscale ultrasound was employed.

Method

A total of 207 patients were assessed from June to November 2021 after getting informed consent. The association between ATI values and greyscale grading to diagnose hepatic steatosis was investigated, and the Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the data. In the analysis, the Spearman correlation and area under the receiver operating characteristic curve (AUROC) tests were performed. Receiver operating characteristic curve analysis was also used to assess ATI’s diagnostic capability and cutoff values.

Result

The correlation between ATI values and hepatic steatosis grades on greyscale was statistically significant (p < 0.05). Greyscale grading and ATI levels have a correlation coefficient (r) of 0.85, indicating a strong association. Steatosis grades 1, 2, and 3 had threshold ATI values of 0.65, 0.73, and 0.96 dB/cm/MHz, respectively. According to greyscale, the diagnostic ability of ATI for steatosis grades 1, 2, and 3 were 0.948 (95% CI: 0.917-0.979), 0.978 (95% CI: 0.961-0.995), and 1.000 (95% CI: 1.000-1.000), respectively.

Conclusions

Attenuation imaging is a reliable method for identifying liver steatosis, with great performance and a strong association with the greyscale ultrasound.

Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

PURPOSE

This study evaluated the accuracy of attenuation imaging (ATI) for the assessment of hepatic steatosis in pediatric patients, in comparison with the FibroScan vibration-controlled transient elastography controlled attenuation parameter (CAP).

METHODS

Consecutive pediatric patients referred for evaluation of obesity who underwent both ATI and FibroScan between February 2020 and September 2021 were included. The correlation between attenuation coefficient (AC) and CAP values was assessed using the Spearman test. The AC cutoff value for discriminating hepatic steatosis corresponding to a CAP value of 241 dB/m was calculated. Multivariable linear regression analysis was performed to estimate the strength of the association between AC and CAP. The diagnostic accuracy of AC cutoffs was estimated using the imperfect gold-standard methodology based on a two-level Bayesian latent class model.

RESULTS

Seventy patients (median age, 12.5 years; interquartile range, 11.0 to 14.0 years; male:female, 58:12) were included. AC and CAP showed a moderate-to-good correlation (ρ =0.646, P<0.001). Multivariable regression analysis affirmed the significant association between AC and CAP (P<0.001). The correlation was not evident in patients with a body mass index ≥30 kg/m2 (ρ=-0.202, P=0.551). Linear regression revealed that an AC cutoff of 0.66 dB/cm/MHz corresponded to a CAP of 241 dB/m (sensitivity, 0.93; 95% confidence interval [CI], 0.85 to 0.98 and specificity, 0.87; 95% CI, 0.56 to 1.00).

CONCLUSION

ATI showed an acceptable correlation with CAP values in a pediatric population, especially in patients with a body mass index <30 kg/m2. An AC cutoff of 0.66 dB/cm/MHz, corresponding to a CAP of 241 dB/m, can accurately diagnose hepatic steatosis.