Head-to-head comparison of dual-elastography and 2D shear wave elastography for assessing steatosis, fibrosis, and
Guangwen Cheng1, Xueqi Li1, Jing Liang1
1Department of Ultrasound, Huashan Hospital, Fudan University, No. 12 Urumqi Middle Road, Shanghai 200040, China.
Background:
Quantitative ultrasound techniques enable noninvasive assessment of hepatic steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease (MASLD). This study performed a head-to-head comparison of dual-elastography and 2D shear wave elastography (2D-SWE) for comprehensive histologic evaluation.
Methods:
A total of 186 biopsy proven MASLD patients were enrolled. Dual-elastography provided attenuation imaging (ATI), fibrosis (F-index), and inflammatory activity (A-index), while 2D-SWE offered attenuation coefficient (ATT), shear wave elasticity (SWE), and shear wave dispersion (SWD). Histologic grades of steatosis (S0-S3), fibrosis (F0-F3), and inflammation (A0-A3) served as the reference standard. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.
Results:
ATI outperformed ATT for detecting ≥S1 steatosis (AUROC 0.90 vs. 0.81, P = 0.036), while their performance for ≥S2 and ≥S3 was comparable. For significant fibrosis (≥F2), the F-index showed higher accuracy than SWE (AUROC 0.87 vs. 0.80, P = 0.046) with greater sensitivity (73.7%) and balanced specificity (85.3%). SWD demonstrated moderate diagnostic ability for inflammatory activity (AUROC 0.75 for ≥A2; 0.84 for ≥A3), and the A-index achieved AUROC 0.73 for detecting lobular inflammation grade ≥2.
Conclusions:
ATI and ATT are reliable for assessing steatosis, the F-index provides superior accuracy for significant fibrosis, and SWD and A-index reflect overall and lobular inflammation, respectively. These multiparametric ultrasound techniques enable comprehensive, noninvasive evaluation of key histologic features in MASLD.
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