{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:00:09Z","timestamp":1781067609790,"version":"3.54.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study directly compares the diagnostic performance of two routinely available, non-invasive techniques\u2014ultrasound-derived fat fraction (UDFF) and non-contrast computed tomography (NCCT)\u2014for screening and grading hepatic steatosis (HS). In addition, it exploratorily assesses the utility of liver stiffness measurement (LSM) for quantifying liver fat content.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective single-center study, 78 patients with chronic liver disease (CLD) were recruited and underwent NCCT, ultrasound [UDFF and Automatic Point Shear Wave Elastography (Auto-pSWE)], and magnetic resonance imaging-proton density fat fraction (MRI-PDFF) within 1 week. The same cohort was analyzed using two different MRI-PDFF threshold criteria: the primary set and the alternative set. In the primary set, Spearman's correlation coefficients assessed relationships among UDFF, CT liver-to-spleen attenuation ratio [CT(L\/S)], LSM, and MRI-PDFF. The diagnostic performance of UDFF and CT(L\/S) for grading HS was evaluated using ROC curves with bootstrap AUC comparisons. Agreement and reliability were assessed using ICC and kappa statistics, and influencing factors were examined by logistic regression. In the alternative set, the diagnostic performance of UDFF and CT(L\/S) for grading steatosis was similarly evaluated using ROC curves with bootstrap AUC comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After excluding three patients, 75 were included in the final analysis. In the primary set, for HS \u2265 S1, UDFF (AUC = 0.926; cutoff 8.5%) outperformed CT(L\/S) (AUC = 0.826; cutoff 0.95;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). For HS \u2265 S2, both methods performed similarly [UDFF AUC = 0.961; CT(L\/S) AUC = 0.943;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt; 0.05]. Grading diagnosis agreement was good between UDFF and MRI-PDFF (\u03ba = 0.740), but only moderate for CT(L\/S) (\u03ba = 0.517). UDFF demonstrated higher inter-operator (ICC = 0.949) and intra-operator (ICC = 0.967) reliability than CT(L\/S). Triglyceride level was the determinant factor for UDFF (OR = 8.510,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). In the Alternative Set, UDFF also outperformed CT(L\/S) for HS \u2265 S1 (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05), with no significant difference for HS \u2265 S2 (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>UDFF outperforms CT(L\/S) in steatosis grading and reliability but is limited to the Siemens DAX probe, whereas CT(L\/S) is equipment-independent but less reliable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1799359","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:29:52Z","timestamp":1781065792000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing ultrasound-derived fat fraction and CT for diagnosing hepatic steatosis: an MRI-PDFF reference study"],"prefix":"10.3389","volume":"13","author":[{"given":"Huizhen","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwen","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuli","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Third People's Hospital of Chengdu","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1542","DOI":"10.1097\/HEP.0000000000000696","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Lazarus","year":"2023","journal-title":"J Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"10633","DOI":"10.3390\/ijms241310633","article-title":"Chronic liver disease: latest research in pathogenesis, detection and treatment","volume":"24","author":"De Siervi","year":"2023","journal-title":"Int J Mol Sci."},{"key":"B4","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1111\/apt.15575","article-title":"Systematic review: chronic viral hepatitis and metabolic derangement","volume":"51","author":"Wang","year":"2020","journal-title":"Aliment Pharmacol Ther."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1007\/s11695-023-06568-5","article-title":"Application of scores assessing histological activity and estimated long-term risk analysis of hepatic decompensation of non-alcoholic fatty liver disease in individuals undergoing bariatric surgery","volume":"33","author":"Hatto","year":"2023","journal-title":"Obes Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1794","DOI":"10.1007\/s00330-024-11001-1","article-title":"Evaluation of MRI proton density fat fraction in hepatic steatosis: a systematic review and meta-analysis","volume":"35","author":"Azizi","year":"2025","journal-title":"Eur Radiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1067\/j.cpradiol.2022.07.014","article-title":"Prevalence of hepatic steatosis in adults presenting to the emergency department identified by unenhanced chest CT","volume":"52","author":"Garg","year":"2023","journal-title":"Curr Probl Diagn Radiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.1016\/j.transproceed.2019.02.047","article-title":"Body mass index and unenhanced CT as a predictor of hepatic steatosis in potential liver donors","volume":"51","author":"Adali","year":"2019","journal-title":"Transplant Proc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e241171","DOI":"10.1148\/radiol.241171","article-title":"Diagnostic accuracy of CT for the detection of hepatic steatosis: a systematic review and meta-analysis","volume":"313","author":"Haghshomar","year":"2024","journal-title":"Radiology."},{"key":"B10","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12876-023-02717-3","article-title":"CT-based Hounsfield unit values reflect the degree of steatohepatitis in patients with low-grade fatty liver disease","volume":"23","author":"Kim","year":"2023","journal-title":"BMC Gastroenterol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.3390\/diagnostics11122168","article-title":"Association of hepatic steatosis index with nonalcoholic fatty liver disease diagnosed by non-enhanced CT in a screening population","volume":"11","author":"Chung","year":"2021","journal-title":"Diagnostics."},{"key":"B12","doi-asserted-by":"publisher","first-page":"4427","DOI":"10.1007\/s00330-018-5905-1","article-title":"CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: development and validation of diagnostic cut-off values in a large cohort with pathological reference standard","volume":"29","author":"Byun","year":"2019","journal-title":"Eur Radiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.jhep.2024.04.031","article-title":"EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)","volume":"81","year":"2024","journal-title":"J Hepatol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1016\/j.ultrasmedbio.2024.03.014","article-title":"WFUMB guidelines\/guidance on liver multiparametric ultrasound. Part 2: Guidance on Liver Fat Quantification","volume":"50","author":"Ferraioli","year":"2024","journal-title":"Ultrasound Med Biol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"784","DOI":"10.2214\/AJR.22.27878","article-title":"Quantification of hepatic steatosis by ultrasound: prospective comparison with MRI proton density fat fraction as reference standard","volume":"219","author":"Dillman","year":"2022","journal-title":"AJR Am J Roentgenol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s10396-024-01472-6","article-title":"Diagnostic accuracy of ultrasound-derived fat fraction for the detection and quantification of hepatic steatosis in patients with liver biopsy","volume":"52","author":"Nakamura","year":"2025","journal-title":"J Med Ultrason"},{"key":"B17","doi-asserted-by":"publisher","first-page":"733","DOI":"10.3390\/biom12050733","article-title":"Relationship between liver stiffness and steatosis in obesity conditions: in vivo and in vitro studies","volume":"12","author":"Baldini","year":"2022","journal-title":"Biomolecules."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e70123","DOI":"10.1002\/mco2.70123","article-title":"Noninvasive quantification of hepatic steatosis using ultrasound-derived fat fraction (CHESS2303): a prospective multicenter study","volume":"6","author":"Huang","year":"2025","journal-title":"MedComm."},{"key":"B19","doi-asserted-by":"publisher","first-page":"e13446","DOI":"10.1111\/eci.13446","article-title":"A meta-analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease","volume":"51","author":"Gu","year":"2021","journal-title":"Eur J Clin Invest."},{"key":"B20","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1148\/radiol.14140754","article-title":"Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease","volume":"274","author":"Tang","year":"2015","journal-title":"Radiology."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.3390\/diagnostics13111852","article-title":"Non-invasive imaging methods to evaluate non-alcoholic fatty liver disease with fat quantification: a review","volume":"13","author":"Jang","year":"2023","journal-title":"Diagnostics."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1007\/s00261-022-03506-4","article-title":"Quantitative analysis of the risk of type 2 diabetes and fatty liver in non-obese individuals by computed tomography","volume":"47","author":"Tang","year":"2022","journal-title":"Abdom Radiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/s13244-025-02092-5","article-title":"Ultrasound-derived fat fraction for the noninvasive quantification of hepatic steatosis: a prospective multicenter study","volume":"16","author":"Xue","year":"2025","journal-title":"Insights Imaging."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1186\/s40001-025-03229-4","article-title":"Discovery of ultrasound-derived fat fraction as a non-invasive tool for MASLD diagnosis","volume":"30","author":"Jin","year":"2025","journal-title":"Eur J Med Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"344","DOI":"10.14366\/usg.21150","article-title":"Noninvasive assessment of hepatic steatosis using a pathologic reference standard: comparison of CT, MRI, and US-based techniques","volume":"41","author":"Bae","year":"2022","journal-title":"Ultrasonography."},{"key":"B26","doi-asserted-by":"publisher","first-page":"656658","DOI":"10.3389\/fmed.2021.656658","article-title":"Test-retest reliability of the assessment of fatty liver disease using low-dose computed tomography in cardiac patients","volume":"8","author":"Hokkanen","year":"2021","journal-title":"Front Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"5749","DOI":"10.12998\/wjcc.v12.i25.5749","article-title":"Prevalence of nonalcoholic fatty liver disease in patients with hepatitis B: a meta-analysis","volume":"12","author":"Zhang","year":"2024","journal-title":"World J Clin Cases."},{"key":"B28","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.dld.2025.11.008","article-title":"Ultrasound-derived visceral adipose tissue as a reliable marker of hepato-metabolic risk in patients with MASLD","volume":"58","author":"Flagiello","year":"2026","journal-title":"Dig Liver Dis."},{"key":"B29","doi-asserted-by":"publisher","first-page":"10062","DOI":"10.1038\/s41598-023-37281-z","article-title":"Usefulness of two-dimensional shear wave elastography in the assessment of non-alcoholic fatty liver disease in children and adolescents","volume":"13","author":"Yoon","year":"2023","journal-title":"Sci Rep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1111\/liv.15116","article-title":"Inflammatory activity affects the accuracy of liver stiffness measurement by transient elastography but not by two-dimensional shear wave elastography in non-alcoholic fatty liver disease","volume":"42","author":"Mendoza","year":"2022","journal-title":"Liver Int."},{"key":"B31","doi-asserted-by":"publisher","first-page":"604","DOI":"10.2214\/AJR.22.27656","article-title":"Liver stiffness Measurements by 2D shear-wave elastography: effect of steatosis on fibrosis evaluation","volume":"219","author":"Kumada","year":"2022","journal-title":"AJR Am J Roentgenol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1799359\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:29:53Z","timestamp":1781065793000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1799359\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":31,"alternative-id":["10.3389\/fmed.2026.1799359"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1799359","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"article-number":"1799359"}}