Ultrasonography.  2020 Apr;39(2):121-129. 10.14366/usg.19034.

Reproducibility of ultrasound attenuation imaging for the noninvasive evaluation of hepatic steatosis

• Yoo J
• Lee JM
• Joo I
• Lee DH
• Yoon JH
• Kang HJ
• Ahn SJ

• KMID: 2501439
• DOI: http://doi.org/10.14366/usg.19034

Abstract

Purpose
The purpose of this study was to evaluate the intra-observer reproducibility of ultrasound attenuation imaging (ATI) for the noninvasive assessment of hepatic steatosis in patients with suspected hepatic steatosis and the inter-observer reproducibility in asymptomatic volunteers.
Methods
This prospective study was approved by our institutional review board and informed consent was obtained from all patients. In group 1, composed of patients with suspected hepatic steatosis (n=143), one abdominal radiologist performed gray-scale ultrasonography and two sessions of ATI. In group 2, composed of healthy volunteers (n=18), three independent sessions of ATI were performed by three abdominal radiologists. The visual degree of hepatic steatosis in all study subjects was graded on a 4-point scale by two independent reviewers using gray-scale ultrasonography. Thereafter, the attenuation coefficient (AC) was correlated with the degree of hepatic steatosis using Spearman rank correlation analysis. Intra-class correlation coefficients (ICCs) were used to assess the intra-observer (group 1) and inter-observer reproducibility (group 2) of ATI measurements.
Results
For the intra-observer reproducibility of ATI, the ICC was 0.929 (95% confidence interval [CI], 0.901 to 0.949), and the coefficient of variation was 7.1%. Inter-observer reproducibility of ATI measurements showed an ICC of 0.792 (95% CI, 0.549 to 0.916). The AC showed a significant correlation with the visual grade of hepatic steatosis for both reviewers (rho, 0.780 and 0.695; P<0.001, respectively).
Conclusion
ATI showed high intra- and inter-observer reproducibility in the assessment of hepatic steatosis.

Keyword

Ultrasonography; Non-alcoholic fatty liver disease; Obesity

Figure

• 

  Fig. 1. Gray-scale ultrasound and attenuation imaging (ATI) in a 48-year-old man with hepatic steatosis.A. Gray-scale ultrasound imaging shows increased liver echogenicity with obscured periportal echogenicity and preserved diaphragmatic echogenicity. Both reviewers 1 and 2 assessed the degree of steatosis as 2 (moderate). B. ATI was performed in the right lobe of the liver through an intercostal scan. The level of attenuation was color-coded and displayed in the region of interest (ROI), excluding vascular structures. The ultrasound system automatically displays the attenuation coefficient (dB/cm/MHz) and the coefficient of determination (R2 value) to optimize the accuracy of ROI placement.

• 

  Fig. 2. Box-and-whisker plots of the mean attenuation coefficient according to the visually assessed steatosis grade of both (A) reviewer 1 and (B) reviewer 2.A, B. Boxes show the median and 25th and 75th percentiles, and whiskers show the minimum and maximum values. Horizontal brackets mean significant differences between each steatosis grade using the Jonckheere-Terpstra and Mann-Whitney U tests. ATI, attenuation imaging.

Reference

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