Discovery of ultrasound-derived fat fraction as a non-invasive tool for MASLD diagnosis

Huiru Jin; Mengfan Jiao; Chengxiao Yu; Tingting Ren; Qingling Chen; Zixing Dai; Erfu Xie; Longfeng Jiang; Yuwen Li

doi:10.1186/s40001-025-03229-4

Discovery of ultrasound-derived fat fraction as a non-invasive tool for MASLD diagnosis

Eur J Med Res. 2025 Oct 24;30(1):1014. doi: 10.1186/s40001-025-03229-4.

Authors

Huiru Jin^#¹, Mengfan Jiao^#¹, Chengxiao Yu^#^{2

3}, Tingting Ren¹, Qingling Chen¹, Zixing Dai¹, Erfu Xie⁴, Longfeng Jiang⁵, Yuwen Li⁶

Affiliations

¹ Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
² Health Management Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
³ Department of Health Management, School of Public Health, Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
⁴ Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical, 300 Guangzhou Rd, Nanjing, 210029, China.
⁵ Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. longfengjiang@njmu.edu.cn.
⁶ Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China. ywli@jsph.org.cn.

^# Contributed equally.

Abstract

Background: This study aimed to evaluate the diagnostic performance of ultrasound-derived fat fraction (UDFF) for metabolic dysfunction-associated steatotic liver disease (MASLD), by directly comparing it with the non-invasive gold standard MRI-PDFF and the established ultrasound method CAP.

Methods: The diagnostic criteria for MASLD were used, we included 103 individuals with 53 MASLD patients and 49 healthy controls. All participants underwent liver MRI for MRI-PDFF quantification; ultrasound elastography for UDFF measurement; and vibration-controlled transient elastography for CAP assessment. Receiver operating characteristic (ROC) curves were generated to evaluate the performance of UDFF and CAP for predicting MRI-PDFF ≥ 5%, the imaging threshold defining hepatic steatosis in MASLD diagnosis. Finally, we analyzed the correlation between UDFF and serological indicators and the consistency between UDFF and MRI-PDFF.

Results: Across all 103 participants, the median UDFF value was 6.0%, median CAP was 246 dB/m, and median MRI-PDFF was 5.44%. Overall, UDFF was positively correlated with MRI-PDFF (R = 0.876; P < 0.001), and CAP was positively correlated with MRI-PDFF (R = 0.792, P < 0.001). For diagnosing 5% and above MRI-PDFF, UDFF was noted to have a mean AUC of 0.981. Additionally, CAP was noted to have an AUC of 0.932 in diagnosing MASLD. In addition, the Bland-Altman difference plots showed overall UDFF and MRI-PDFF, with a mean deviation of -0.2%. A linear regression model between the difference and the mean suggested proportional error.

Conclusions: Ultrasound testing for UDFF provides a simple and noninvasive clinical tool to quantify the extent of hepatic steatosis. The diagnostic efficacy of UDFF is superior to CAP. Notably, while UDFF shows strong agreement with MRI-PDFF overall, Bland-Altman analysis revealed a proportional bias, with UDFF tending to underestimate MRI-PDFF at higher fat content levels. Despite this limitation, UDFF demonstrates potential as a noninvasive alternative to MRI-PDFF for MASLD diagnosis.

Keywords: Controlled attenuation parameter; Hepatic steatosis; Metabolic dysfunction-associated steatotic liver disease; Proton density fat fraction; Ultrasound-derived fat fraction.

MeSH terms

Adipose Tissue* / diagnostic imaging
Adult
Aged
Case-Control Studies
Elasticity Imaging Techniques / methods
Fatty Liver* / diagnosis
Fatty Liver* / diagnostic imaging
Female
Humans
Magnetic Resonance Imaging / methods
Male
Middle Aged
ROC Curve
Ultrasonography / methods