Ultrasound Attenuation Estimation in Harmonic Imaging for Robust Fatty Liver Detection

Accurate detection of liver steatosis is important for liver disease management. Ultrasound attenuation coefficient estimation (ACE) has great potential in quantifying liver fat content. The commonly used ACE methods (e.g., spectral shift methods, reference phantom methods) assume linear tissue response to ultrasound and were developed in fundamental imaging. However, fundamental imaging may be vulnerable to reverberation clutters introduced by the body wall. The clutters superimposed on liver echoes may bias the attenuation estimation. Here we propose a new ACE technique, the reference frequency method (RFM), in harmonic imaging to mitigate the reverberation bias. The accuracy of harmonic RFM was validated through a phantom study. In a pilot patient study, harmonic RFM performed more robustly in vivo compared with fundamental RFM, illustrating the potential of ACE in harmonic imaging.