{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T20:22:05Z","timestamp":1777062125212,"version":"3.51.4"},"reference-count":28,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T00:00:00Z","timestamp":1698710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Culture and Innovation of Hungary","award":["\u00daNKP\u201323\u20133\u2013SE\u2013"],"award-info":[{"award-number":["\u00daNKP\u201323\u20133\u2013SE\u2013"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>We aimed to develop a non-linear regression model that could predict the fat fraction of the liver (UEFF), similar to magnetic resonance imaging proton density fat fraction (MRI-PDFF), based on quantitative ultrasound (QUS) parameters. We measured and retrospectively collected the ultrasound attenuation coefficient (AC), backscatter-distribution coefficient (BSC-D), and liver stiffness (LS) using shear wave elastography (SWE) in 90 patients with clinically suspected non-alcoholic fatty liver disease (NAFLD), and 51 patients with clinically suspected metabolic-associated fatty liver disease (MAFLD). The MRI-PDFF was also measured in all patients within a month of the ultrasound scan. In the linear regression analysis, only AC and BSC-D showed a significant association with MRI-PDFF. Therefore, we developed prediction models using non-linear least squares analysis to estimate MRI-PDFF based on the AC and BSC-D parameters. We fitted the models on the NAFLD dataset and evaluated their performance in three-fold cross-validation repeated five times. We decided to use the model based on both parameters to calculate UEFF. The correlation between UEFF and MRI-PDFF was strong in NAFLD and very strong in MAFLD. According to a receiver operating characteristics (ROC) analysis, UEFF could differentiate between &lt;5% vs. \u22655% and &lt;10% vs. \u226510% MRI-PDFF steatosis with excellent, 0.97 and 0.91 area under the curve (AUC), accuracy in the NAFLD and with AUCs of 0.99 and 0.96 in the MAFLD groups. In conclusion, UEFF calculated from QUS parameters is an accurate method to quantify liver fat fraction and to diagnose \u22655% and \u226510% steatosis in both NAFLD and MAFLD. Therefore, UEFF can be an ideal non-invasive screening tool for patients with NAFLD and MAFLD risk factors.<\/jats:p>","DOI":"10.3390\/diagnostics13213353","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T12:48:31Z","timestamp":1698756511000},"page":"3353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Calculation and Evaluation of an Ultrasound-Estimated Fat Fraction in Non-Alcoholic Fatty Liver Disease and Metabolic-Associated Fatty Liver Disease"],"prefix":"10.3390","volume":"13","author":[{"given":"P\u00e1l Nov\u00e1k","family":"Kaposi","sequence":"first","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2369-0329","authenticated-orcid":false,"given":"Zita","family":"Zsombor","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2278-0058","authenticated-orcid":false,"given":"Alad\u00e1r D.","family":"R\u00f3nasz\u00e9ki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3982-7887","authenticated-orcid":false,"given":"Bettina K.","family":"Budai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Csongr\u00e1dy","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00f3bert","family":"Stollmayer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ildik\u00f3","family":"Kalina","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriella","family":"Gy\u0151ri","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor","family":"B\u00e9rczi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kl\u00e1ra","family":"Werling","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, \u00dcll\u0151i \u00fat 78., 1082 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e1l","family":"Maurovich-Horvat","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anik\u00f3","family":"Folhoffer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Kor\u00e1nyi S. u. 2\/A., 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krisztina","family":"Hagym\u00e1si","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, \u00dcll\u0151i \u00fat 78., 1082 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1097\/HEP.0000000000000004","article-title":"The Global Epidemiology of Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH): A Systematic Review","volume":"77","author":"Younossi","year":"2023","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2016). EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. J. Hepatol., 64, 1388\u20131402.","DOI":"10.1016\/j.jhep.2015.11.004"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jhep.2020.03.039","article-title":"A New Definition for Metabolic Dysfunction-Associated Fatty Liver Disease: An International Expert Consensus Statement","volume":"73","author":"Eslam","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_4","first-page":"9026","article-title":"Role of Liver Biopsy in Nonalcoholic Fatty Liver Disease","volume":"20","author":"Nalbantoglu","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3564","DOI":"10.1007\/s00330-019-06072-4","article-title":"Diagnostic Value of MRI-PDFF for Hepatic Steatosis in Patients with Non-Alcoholic Fatty Liver Disease: A Meta-Analysis","volume":"29","author":"Gu","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1016\/j.ultrasmedbio.2021.06.002","article-title":"Quantification of Liver Fat Content with Ultrasound: A WFUMB Position Paper","volume":"47","author":"Ferraioli","year":"2021","journal-title":"Ultrasound Med. Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.3748\/wjg.v29.i17.2534","article-title":"Non-Invasive Evaluation of Liver Steatosis with Imaging Modalities: New Techniques and Applications","volume":"29","author":"Zeng","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zsombor, Z., R\u00f3nasz\u00e9ki, A.D., Csongr\u00e1dy, B., Stollmayer, R., Budai, B.K., Folhoffer, A., Kalina, I., Gy\u0151ri, G., B\u00e9rczi, V., and Maurovich-Horvat, P. (2023). Evaluation of Artificial Intelligence-Calculated Hepatorenal Index for Diagnosing Mild and Moderate Hepatic Steatosis in Non-Alcoholic Fatty Liver Disease. Medicina, 59.","DOI":"10.3390\/medicina59030469"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3348\/kjr.2020.1262","article-title":"Quantitative Ultrasound Radiofrequency Data Analysis for the Assessment of Hepatic Steatosis in Nonalcoholic Fatty Liver Disease Using Magnetic Resonance Imaging Proton Density Fat Fraction as the Reference Standard","volume":"22","author":"Jeon","year":"2021","journal-title":"Korean J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e29708","DOI":"10.1097\/MD.0000000000029708","article-title":"Tissue Attenuation Imaging and Tissue Scatter Imaging for Quantitative Ultrasound Evaluation of Hepatic Steatosis","volume":"101","author":"Budai","year":"2022","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1177\/08465371221123696","article-title":"Hepatic Fat Quantification With Novel Ultrasound Based Techniques: A Diagnostic Performance Study Using Magnetic Resonance Imaging Proton Density Fat Fraction as Reference Standard","volume":"74","author":"Cerit","year":"2023","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1148\/radiol.210736","article-title":"US Attenuation for Liver Fat Quantification: An AIUM-RSNA QIBA Pulse-Echo Quantitative Ultrasound Initiative","volume":"302","author":"Ferraioli","year":"2022","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1148\/radiol.220606","article-title":"US Backscatter for Liver Fat Quantification: An AIUM-RSNA QIBA Pulse-Echo Quantitative Ultrasound Initiative","volume":"305","author":"Wear","year":"2022","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"136","DOI":"10.14366\/usg.20042","article-title":"Quantitative Ultrasound Radiofrequency Data Analysis for the Assessment of Hepatic Steatosis Using the Controlled Attenuation Parameter as a Reference Standard","volume":"40","author":"Jeon","year":"2021","journal-title":"Ultrasonography"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1109\/TUFFC.2012.2302","article-title":"Effects of Frequency and Bandwidth on Diagnostic Information Transfer in Ultrasonic B-Mode Imaging","volume":"59","author":"Abbey","year":"2012","journal-title":"IEEE Trans. Ultrason. Ferroelectr. Freq. Control"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1002\/jum.16242","article-title":"Liver Fat Quantification With Ultrasound: Depth Dependence of Attenuation Coefficient","volume":"42","author":"Ferraioli","year":"2023","journal-title":"J. Ultrasound Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1002\/jum.15364","article-title":"Novel Method for Ultrasound-Derived Fat Fraction Using an Integrated Phantom","volume":"39","author":"Labyed","year":"2020","journal-title":"J. Ultrasound Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1148\/radiol.2020191152","article-title":"Assessment of Hepatic Steatosis in Nonalcoholic Fatty Liver Disease by Using Quantitative US","volume":"295","author":"Han","year":"2020","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/jcu.22771","article-title":"Interobserver Agreement and Diagnostic Accuracy of Shearwave Elastography for the Staging of Hepatitis C Virus-Associated Liver Fibrosis","volume":"48","author":"Kaposi","year":"2019","journal-title":"J. Clin. Ultrasound"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1148\/radiol.2020192437","article-title":"Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement","volume":"296","author":"Barr","year":"2020","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Orcel, T., Chau, H.T., Turlin, B., Chaigneau, J., Bannier, E., Otal, P., Frampas, E., Leguen, A., Boulic, A., and Saint-Jalmes, H. (Eur. Radiol., 2023). Evaluation of Proton Density Fat Fraction (PDFF) Obtained from a Vendor-Neutral MRI Sequence and MRQuantif Software, Eur. Radiol., Epub ahead of print.","DOI":"10.1007\/s00330-023-09798-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1002\/nbm.1622","article-title":"In Vivo Characterization of the Liver Fat 1H MR Spectrum","volume":"24","author":"Hamilton","year":"2011","journal-title":"NMR Biomed."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1148\/radiol.211131","article-title":"Direct Comparison of Quantitative US versus Controlled Attenuation Parameter for Liver Fat Assessment Using MRI Proton Density Fat Fraction as the Reference Standard in Patients Suspected of Having NAFLD","volume":"304","author":"Jung","year":"2022","journal-title":"Radiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1148\/radiol.2020191160","article-title":"Noninvasive Diagnosis of Nonalcoholic Fatty Liver Disease and Quantification of Liver Fat with Radiofrequency Ultrasound Data Using One-Dimensional Convolutional Neural Networks","volume":"295","author":"Han","year":"2020","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e221510","DOI":"10.1148\/radiol.221510","article-title":"Two-Dimensional Convolutional Neural Network Using Quantitative US for Noninvasive Assessment of Hepatic Steatosis in NAFLD","volume":"307","author":"Jeon","year":"2023","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1002\/hep4.1948","article-title":"Relationship between Controlled Attenuated Parameter and Magnetic Resonance Imaging-Proton Density Fat Fraction for Evaluating Hepatic Steatosis in Patients with NAFLD","volume":"6","author":"An","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1002\/hep.29639","article-title":"Optimal Threshold of Controlled Attenuation Parameter with MRI-PDFF as the Gold Standard for the Detection of Hepatic Steatosis","volume":"67","author":"Caussy","year":"2018","journal-title":"Hepatology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/s41574-021-00584-0","article-title":"Non-Invasive Methods for Imaging Hepatic Steatosis and Their Clinical Importance in NAFLD","volume":"18","author":"Tamaki","year":"2022","journal-title":"Nat. Rev. Endocrinol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/21\/3353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:14:46Z","timestamp":1760130886000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/21\/3353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,31]]},"references-count":28,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["diagnostics13213353"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13213353","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,31]]}}}