Comparing Three Ultrasound-Based Techniques for Diagnosing and Grading Hepatic Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease

To compare the diagnostic accuracy and grading ability of ultrasound-derived fat fraction (UDFF), controlled attenuation parameters (CAP), and hepatic/renal ratio (HRR) for hepatic steatosis in metabolic dysfunction-associated steatotic liver disease (MASLD) using magnetic resonance imaging proton density fat fraction (PDFF) as the gold standard. Patients suspected of having MASLD in our hospital between October 2023 and May 2024 were divided into the MASLD group and the control group. All patients underwent UDFF, CAP, and PDFF examinations. HRR was measured during routine ultrasound examination. In statistical analysis, we initially assessed the correlation between UDFF, CAP, HRR, and general characteristics of subjects with PDFF. Subsequently, receiver operating characteristic curve were employed to evaluate and compare the diagnostic performance of UDFF, CAP, and HRR for different grades of hepatic steatosis in MASLD. Their area under the curve, optimal cut-off value, sensitivity, and specificity were also determined. Finally, predictive factors determined hepatic steatosis in MASLD (PDFF≥6%) were identified through binary logistic regression analysis. 115 individuals were ultimately included in the MASLD group, while 102 were included in the control group. UDFF, CAP, and HRR were all positively correlated with PDFF. Among them, UDFF exhibited the strongest correlation with PDFF (ρ = 0.91). Furthermore, in the comparison of diagnostic efficacy among different grades of hepatic steatosis, UDFF outperformed CAP and HRR (p