Diagnostic performance of ultrasound-derived fat fraction for grading hepatic steatosis in patients with chronic liver diseases: a multicenter study.

Abstract

To investigate the diagnostic performance of ultrasound-derived fat fraction (UDFF) using the DAX probe for evaluating hepatic steatosis in chronic liver disease (CLD) patients with liver biopsy. Possible influencing factors such as etiology, stage of necroinflammation, fibrosis, and anthropometric indices were also evaluated. This prospective multicenter study enrolled CLD patients between October 2024 and June 2025. The diagnostic performance of UDFF was evaluated by the area under the receiver-operating characteristic curve (AUC) with liver biopsy as the reference standard. Subgroup analysis was performed in different etiologies, stages of necroinflammation, fibrosis, and anthropometric indices. Among the total of 255 patients (mean age, 51.27 years ± 11.24; 148 men), 146 (57.25%) had no steatosis (S0). The AUC of UDFF for detecting hepatic steatosis ≥ S1, ≥ S2, and = S3 were 0.914 (95% confidence interval (CI): 0.873-0.946), 0.950 (95% CI: 0.916-0.974), and 0.916 (95% CI: 0.875-0.947), respectively. The optimal cutoff values were: 7% for ≥ S1 (109, 42.75%), 11% for ≥ S2 (79, 30.98%), and 18% for = S3 (39, 15.30%). UDFF also demonstrated AUC > 0.9 for detecting hepatic steatosis ≥ S1 in following subgroups: (1) with necroinflammation (n = 164); (2) with advanced fibrosis (n = 61); (3) with skin-to-capsule distance ≥ 1.9 cm (n = 129); (4) with intercostal distance ≤ 2.5 cm (n = 162); (5) excluding isolated metabolic dysfunction-associated steatotic liver disease (n = 178). UDFF measured with the DAX probe excellently detected and graded hepatic steatosis in CLD patients regardless of etiology, stage of necroinflammation, fibrosis, or anthropometric indices. Question Can UDFF reliably grade hepatic steatosis in CLD patients, regardless of etiology, necroinflammation, or fibrosis? Findings In this mixed-etiology population of 255 CLD patients, UDFF demonstrated high diagnostic performance for grading steatosis, consistent across diverse etiologies, necroinflammation, and fibrosis stages. Clinical relevance UDFF provides a reliable alternative to liver biopsy for quantifying hepatic steatosis in CLD, enabling accurate diagnosis and timely monitoring without invasive procedures.