Comparison of conventional sonographic signs and magnetic resonance imaging proton density fat fraction for assessment of hepatic steatosis

Mimi Kim, Bo-Kyeong Kang, Dae Won Jun, Mimi Kim, Bo-Kyeong Kang, Dae Won Jun

Abstract

This study correlated conventional ultrasonography (US) signs with the magnetic resonance imaging (MRI) proton density fat fraction (PDFF) to evaluate the diagnostic performance of US signs (alone or combined) to predict presence and degree of hepatic steatosis (HS). Overall, 182 subjects met the study inclusion criteria between February 2014 and October 2016. Four US signs were evaluated independently by two radiologists. MRI PDFF was defined as the average of 24 non-overlapping regions of interest (ROIs) within eight liver segments obtained by drawing three ROIs within each segment. The latter acted as the reference standard to evaluate diagnostic accuracy of the US signs and their combinations. Diagnostic performance of US for HS was assessed using receiver operating characteristic (ROC) curve analyses. There was a strongly positive correlation between some combinations of US signs and PDFF (σ = 0.780, p < 0.001). The sensitivity, specificity, PPV, and NPV were 96.6%, 74.8%, 64.8%, and 97.9%, respectively, determined using abnormal hepatorenal echoes to detect grade 1 or higher HS (area under the ROC curve = 0.875). The sensitivity and NPV for detecting HS with US were good and US may be considered a suitable screening tool for exclusion of HS.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow diagram of patient selection.
Figure 2
Figure 2
Classic examples of the four signs observed on ultrasonography. (a) Abnormal hepatorenal echo (liver had higher echogenicity than the right renal cortex). (b) Loss of echogenicity of portal vein (the echogenic wall of the main portal vein was not visible in the right intercostal view). (c) Posterior beam attenuation (impaired visualization of more than one-third of the hepatic parenchyma in the right intercostal view). (d) Poor diaphragm visualization (impaired visualization of more than half of the diaphragm in the right intercostal view).
Figure 3
Figure 3
Correlation between the combinations of US signs and the magnetic resonance imaging proton density fat fraction.

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