ARTICLE: LIVER

A Reappraisal of the Diagnostic Performance of B-Mode Ultrasonography for Mild Liver Steatosis

Lee, Chul-min MD, PhD1,*; Yoon, Eileen L. MD, PhD2,*; Nakajima, Atsushi MD, PhD3; Yoneda, Masato MD, PhD3; Toyoda, Hidenori MD, PhD4; Yasuda, Satoshi MD, PhD4; Lee, Jonghyun PhD5; Kim, Mimi MD, PhD1; Kang, Bo-Kyeong MD, PhD1; Nguyen, Mindie H. MD, PhD6; Jun, Dae Won MD, PhD2,5; Sumida, Yoshio MD, PhD7

Author Information

1Department of Radiology, Hanyang University College of Medicine, Seoul, Korea;

2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea;

3Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan;

4Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan;

5Department of Medical and Digital Engineering, Hanyang University College of Engineering, Seoul, Korea;

6Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA;

7Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, Japan.

Correspondence: Dae Won Jun, MD, PhD. E-mail: [email protected]. Yoshio Sumida, MD, PhD. E-mail: [email protected].

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/C710

*Chul-min Lee and Eileen L. Yoon contributed equally to this work as cofirst authors.

**Dae Won Jun and Yoshida Sumida contributed equally to this work as cocorresponding authors.

The American Journal of Gastroenterology 118(5):p 840-847, May 2023. | DOI: 10.14309/ajg.0000000000002020

Abstract

INTRODUCTION: 

Previous studies have shown that ultrasonography has high specificity (80%–100%) but low sensitivity (50%–70%) in diagnosing fatty liver; sensitivity is especially low for mild steatosis. In this study, we aimed to reappraise the diagnostic performance of B-mode ultrasonography (B-USG) for fatty liver disease.

METHODS: 

We performed a retrospective, multinational, multicenter, cross-sectional, observational study (6 referral centers from 3 nations). We included 5,056 participants who underwent both B-USG and magnetic resonance proton density fat fraction (MRI-PDFF) within a 6-month period. The diagnostic performance of B-USG was compared with that of MRI-PDFF as a reference standard for fatty liver diagnosis, using sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and area under the receiver operating characteristic curve (AUC).

RESULTS: 

B-USG showed a sensitivity of 83.4%, specificity of 81.0%, and AUC of 0.822 in diagnosing mild liver steatosis (6.5% ≤MRI-PDFF ≤14%). The sensitivity, specificity, and AUC in diagnosing the presence of fatty liver disease (MRI-PDFF ≥6.5%) were 83.4%, 81.0%, and 0.822, respectively. The mean PDFF of B-USG–diagnosed nonfatty liver differed significantly from that of diagnosed mild liver steatosis (3.5% ± 2.8% vs 8.5% ± 5.0%, P < 0.001). The interinstitutional variability of B-USG in diagnosing fatty liver was similar in diagnostic accuracy among the 6 centers (range, 82.8%–88.6%, P = 0.416).

DISCUSSION: 

B-USG was an effective, objective method to detect mild liver steatosis using MRI-PDFF as comparison, regardless of the etiologies and comorbidities.

© 2022 by The American College of Gastroenterology

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