Evaluation of Ultrasound Shear Wave Elastography (SWE) and Attenuation Imaging (ATI) for the Assessment of Hepatic Fibrosis and Steatosis—A Prospective Comparison With MRI Liver Elastography and Proton Density Fat Fraction (PDFF)

IF 1.5 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology Pub Date : 2026-10-09 Epub Date: 2026-04-03 DOI:10.1111/1754-9485.70093

Jessica Y. Lee, Wayland Wang, Paul Simkin, Beng Ghee Lim, Damien L. Stella, Jeffrey K. C. Lai, Siddharth Sood, Joel Hng, Robert N. Gibson

{"title":"Evaluation of Ultrasound Shear Wave Elastography (SWE) and Attenuation Imaging (ATI) for the Assessment of Hepatic Fibrosis and Steatosis—A Prospective Comparison With MRI Liver Elastography and Proton Density Fat Fraction (PDFF)","authors":"Jessica Y. Lee, Wayland Wang, Paul Simkin, Beng Ghee Lim, Damien L. Stella, Jeffrey K. C. Lai, Siddharth Sood, Joel Hng, Robert N. Gibson","doi":"10.1111/1754-9485.70093","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>To assess competing US techniques in evaluation of chronic liver disease, we performed a study to determine the diagnostic accuracy of 2D-shear wave elastography (2D-SWE) and attenuation imaging (ATI) compared with more established methods of point shear wave elastography (pSWE) and visual B-mode grading of hepatic steatosis. Magnetic resonance elastography (MRE) and proton density fat fraction (MR-PDFF) were used as respective reference standards.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Fifty-five patients underwent same-day liver ultrasound (conventional B-mode, pSWE, 2D-SWE, and ATI) and 3 T MRI (MRE and MR-PDFF). Diagnostic performance for steatosis (mild, moderate, severe) and fibrosis (≥ F2, ≥ F3, and F4) grades was assessed using receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) calculated. Agreement was evaluated using Cohen's kappa for categorical comparisons and intraclass correlation coefficients (ICC) for continuous measurements within the same modality.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>For fibrosis, 2D-SWE demonstrated high sensitivity (100%) for advanced fibrosis (≥ F3; AUC 0.87), compared with pSWE (sensitivity of 71.4%). In contrast, pSWE showed higher specificity (92.3%) for significant fibrosis (≥ F2) compared to 2D-SWE (73.9%). Categorical agreement with MRE was higher for pSWE (kappa = 0.66) than 2D-SWE (kappa = 0.45). For steatosis, visual B-mode across all grades had AUC 0.85–0.89 compared to 0.68–0.85 for ATI. ATI performed best in detecting severe steatosis (AUC 0.85).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Across the spectrum of clinically relevant assessment of liver fibrosis and steatosis, pSWE and visual B-mode grading showed better correlation with MRI results than 2D-SWE and ATI, respectively. However, they did provide good diagnostic performance in grading liver fibrosis and steatosis in advanced disease. Further research may better define more accurate standardised cut-off scores for the 2D-SWE and ATI techniques.</p>\n </section>\n </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"70 7","pages":"611-622"},"PeriodicalIF":1.5000,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Imaging and Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1754-9485.70093","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/4/3 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

To assess competing US techniques in evaluation of chronic liver disease, we performed a study to determine the diagnostic accuracy of 2D-shear wave elastography (2D-SWE) and attenuation imaging (ATI) compared with more established methods of point shear wave elastography (pSWE) and visual B-mode grading of hepatic steatosis. Magnetic resonance elastography (MRE) and proton density fat fraction (MR-PDFF) were used as respective reference standards.

Methods

Fifty-five patients underwent same-day liver ultrasound (conventional B-mode, pSWE, 2D-SWE, and ATI) and 3 T MRI (MRE and MR-PDFF). Diagnostic performance for steatosis (mild, moderate, severe) and fibrosis (≥ F2, ≥ F3, and F4) grades was assessed using receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) calculated. Agreement was evaluated using Cohen's kappa for categorical comparisons and intraclass correlation coefficients (ICC) for continuous measurements within the same modality.

Results

For fibrosis, 2D-SWE demonstrated high sensitivity (100%) for advanced fibrosis (≥ F3; AUC 0.87), compared with pSWE (sensitivity of 71.4%). In contrast, pSWE showed higher specificity (92.3%) for significant fibrosis (≥ F2) compared to 2D-SWE (73.9%). Categorical agreement with MRE was higher for pSWE (kappa = 0.66) than 2D-SWE (kappa = 0.45). For steatosis, visual B-mode across all grades had AUC 0.85–0.89 compared to 0.68–0.85 for ATI. ATI performed best in detecting severe steatosis (AUC 0.85).

Conclusion

Across the spectrum of clinically relevant assessment of liver fibrosis and steatosis, pSWE and visual B-mode grading showed better correlation with MRI results than 2D-SWE and ATI, respectively. However, they did provide good diagnostic performance in grading liver fibrosis and steatosis in advanced disease. Further research may better define more accurate standardised cut-off scores for the 2D-SWE and ATI techniques.

查看原文本刊更多论文

超声剪切波弹性成像（SWE）和衰减成像（ATI）对肝纤维化和脂肪变性评估的评价——与MRI肝弹性成像和质子密度脂肪分数（PDFF）的前瞻性比较。

为了评估美国在慢性肝病评估中的竞争技术，我们进行了一项研究，以确定2d剪切波弹性成像（2D-SWE）和衰减成像（ATI）的诊断准确性，并将其与更成熟的点剪切波弹性成像（pSWE）和肝脂肪变性视觉b模式分级方法进行比较。磁共振弹性成像（MRE）和质子密度脂肪分数（MR-PDFF）分别作为参考标准。方法：55例患者当日行肝脏超声（常规b超、pSWE、2D-SWE和ATI）和3t MRI （MRE和MR-PDFF）检查。采用受试者工作特征（ROC）曲线分析评估脂肪变性（轻度、中度、重度）和纤维化（≥F2、≥F3和F4）等级的诊断效果，并计算曲线下面积（AUC）。使用Cohen’s kappa进行分类比较，使用类内相关系数（ICC）对同一模态内的连续测量进行评估。结果：对于纤维化，2D-SWE对晚期纤维化（≥F3; AUC 0.87）的敏感性（100%）高于pSWE（敏感性为71.4%）。相比之下，pSWE对显著纤维化（≥F2）的特异性（92.3%）高于2D-SWE（73.9%）。pSWE与MRE的分类一致性（kappa = 0.66）高于2D-SWE （kappa = 0.45）。对于脂肪变性，所有分级的视觉b模式的AUC为0.85-0.89，而ATI的AUC为0.68-0.85。ATI对严重脂肪变性的检测效果最好（AUC为0.85）。结论：在肝纤维化和脂肪变性的临床相关评估中，pSWE和视觉b模式分级与MRI结果的相关性分别优于2D-SWE和ATI。然而，它们在晚期疾病的肝纤维化和脂肪变性分级方面确实提供了良好的诊断性能。进一步的研究可能会更好地为2D-SWE和ATI技术定义更准确的标准化截止分数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Medical Imaging and Radiation Oncology 医学-核医学

CiteScore

3.30

自引率

6.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.