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Ultrasound Med Biol. 2018 Nov;44(11):2223-2232. doi: 10.1016/j.ultrasmedbio.2018.06.017. Epub 2018 Aug 2.

The B-Mode Image-Guided Ultrasound Attenuation Parameter Accurately Detects Hepatic Steatosis in Chronic Liver Disease.

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Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan. Electronic address:
Department of Molecular Diagnostic Pathology, Iwate Medical University, Iwate, Japan.
Ultrasound General Imaging, GE Healthcare, Tokyo, Japan.


The purpose of our study was to evaluate the diagnostic accuracy of the ultrasound-guided attenuation parameter (UGAP) for the detection of hepatic steatosis in comparison with the controlled attenuation parameter (CAP), using histopathology as the reference standard. We prospectively analyzed 163 consecutive chronic liver disease patients who underwent UGAP, CAP, computed tomography and a liver biopsy on the same day between April 2016 and July 2017. Radiofrequency signals corresponding to the images were compensated by the reference signal previously measured from the uniform phantom with known attenuation (0.44 dB/cm/MHz). The attenuation coefficient was calculated from the signals' decay slope. The median attenuation coefficient values in patients with S0 (n = 62), S1 (n = 63), S2 (n = 23) and S3 grade (n = 15) were 0.485, 0.560, 0.660 and 0.720, respectively. Significant correlations were found between attenuation coefficient and percentage steatosis, CAP values and liver-to-spleen computed tomography attenuation ratio (p < 0.001). The areas under the receiver operating characteristic curve of UGAP for identifying ≥S1, ≥S2 and ≥S3 were 0.900, 0.953 and 0.959, respectively, which were significantly better than the results obtained with CAP for identifying ≥S2 and ≥S3. In conclusion, UGAP had high diagnostic accuracy for detecting hepatic steatosis in patients with chronic liver disease.


Chronic hepatitis C; Controlled attenuation parameter; Diagnostic ultrasound; Liver steatosis; Non-alcoholic fatty liver disease; Prospective studies

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