Ultrasound-based steatosis grading system using 2D-attenuation imaging: An individual patient data meta-analysis with...

Area of Science:

• Hepatology
• Medical Imaging
• Quantitative Ultrasound

Background:

• Steatotic liver disease (SLD) presents a global health challenge.
• Noninvasive assessment tools for steatosis are crucial for managing SLD.
• Current noninvasive methods require improvement for accurate steatosis grading.

Purpose of the Study:

• To develop and validate a novel steatosis grading system using 2D-attenuation imaging (ATI).
• To establish reliable ATI thresholds for classifying steatosis severity (S0-S3).
• To assess the utility of ATI in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Main Methods:

• A systematic review identified 11 studies (1374 patients) with ATI and histological or MRI-PDFF-verified steatosis.
• One-stage individual patient data (IPD) meta-analysis using generalized mixed models.
• External validation on a prospective cohort (n=174) of patients with type 2 diabetes and MASLD.

Main Results:

• ATI demonstrated significant correlations with histological steatosis (r=0.60) and MRI-PDFF (r=0.70).
• A steatosis grading system (aS0-aS3) was created with calibrated ATI cutoffs (0.66, 0.73, 0.81 dB/cm/MHz).
• External validation showed high accuracy (Obuchowski measures of 0.84 ± 0.02 and 0.82 ± 0.02).

Conclusions:

• 2D-attenuation imaging (ATI) is a dependable noninvasive marker for steatosis.
• The validated ATI-based steatosis grading system offers a valuable tool for MASLD patient assessment.
• This grading system can aid in clinical decision-making and disease management.