{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:03:22Z","timestamp":1789635802600,"version":"4.0.0"},"reference-count":35,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: To evaluate an exploratory ordinal transabdominal ultrasonography score against a study-defined semiquantitative two-echo chemical-shift MRI pancreatic fat index \u2265 5%. Methods: This prospective paired diagnostic accuracy study included 150 adults aged 30\u201360 years with metabolic abnormalities or risk factors and technically adequate ultrasonography. A score \u2265 1 was the primary positive index-test result. Diagnostic accuracy, ROC AUC, and ordinal correspondence were evaluated. Results: After nine clinical exclusions, pancreatic ultrasonography was technically evaluable in 150 of 170 participants (88.2%; 95% CI, 82.5\u201392.3%). For the study-defined MRI index \u2265 5%, sensitivity was 76.8% (95% CI, 66.6\u201384.6%), specificity was 77.9% (95% CI, 66.7\u201386.2%), accuracy was 77.3% (95% CI, 70.0\u201383.3%), and AUC was 0.812 (95% CI, 0.748\u20130.876). Exact four-category agreement was 45.3%, and quadratically weighted kappa was 0.504 (95% CI, 0.387\u20130.612). Conclusions: These estimates describe agreement and discrimination relative to the study-defined two-echo MRI index in selected adults with metabolic risk and technically adequate ultrasonography. They should not be interpreted as diagnostic accuracy for histologically confirmed pancreatic steatosis or standardized MRI-PDFF-defined disease. The exploratory score is not a quantitative substitute for MRI and requires reproducibility assessment and external validation.<\/jats:p>","DOI":"10.3390\/diagnostics16182959","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:34:01Z","timestamp":1789378441000},"page":"2959","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance of Transabdominal Ultrasonography for Pancreatic Fat in Adults with Metabolic Risk Factors for NAFPD: Comparison with a Study-Defined Two-Echo MRI Index"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7288-4986","authenticated-orcid":false,"given":"Anel","family":"Zhangereyeva","sequence":"first","affiliation":[{"name":"Doctoral Program, Non-Profit Joint-Stock Company \u201cAstana Medical University\u201d, 49A Beibitshilik Street, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Venera","family":"Rakhmetova","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases with Courses in Nephrology, Hematology, Allergology, and Immunology, Non-Profit Joint-Stock Company \u201cAstana Medical University\u201d, 49A Beibitshilik Street, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4036-9333","authenticated-orcid":false,"given":"Nurlan","family":"Baisynov","sequence":"additional","affiliation":[{"name":"Research Department, Non-Governmental Educational Institution \u201cKazakhstan-Russian Medical University\u201d, 51\/53 Abylai Khan Avenue, Almaty 050004, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Aitore","family":"Zhangereyev","sequence":"additional","affiliation":[{"name":"Center for Analytical Testing LLP, 5 Kaiym Mukhamedkhanov Street, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e70185","DOI":"10.1002\/ueg2.70185","article-title":"International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG","volume":"14","author":"Vujasinovic","year":"2026","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1038\/nrgastro.2011.4","article-title":"The Clinical Significance of Pancreatic Steatosis","volume":"8","author":"Smits","year":"2011","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1038\/s41575-021-00551-0","article-title":"Intra-Pancreatic Fat Deposition: Bringing Hidden Fat to the Fore","volume":"19","author":"Petrov","year":"2022","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.14309\/ajg.0000000000000262","article-title":"Pancreatic Steatosis: An Emerging Clinical Entity","volume":"114","author":"Ramkissoon","year":"2019","journal-title":"Am. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100933","DOI":"10.1016\/j.gastha.2026.100933","article-title":"The Fatty Pancreas: Current Evidence, Treatment Implications, and Future Directions","volume":"5","author":"Syed","year":"2026","journal-title":"Gastro Hep Adv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.metabol.2016.12.012","article-title":"Ectopic Fat Accumulation in the Pancreas and Its Clinical Relevance: A Systematic Review, Meta-Analysis, and Meta-Regression","volume":"69","author":"Singh","year":"2017","journal-title":"Metabolism"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e3142","DOI":"10.1002\/dmrr.3142","article-title":"The Association between Pancreas Steatosis and Metabolic Syndrome: A Systematic Review and Meta-Analysis","volume":"35","author":"Bi","year":"2019","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1038\/ajg.2014.1","article-title":"Fatty Pancreas, Insulin Resistance, and \u03b2-Cell Function: A Population Study Using Fat-Water Magnetic Resonance Imaging","volume":"109","author":"Wong","year":"2014","journal-title":"Am. J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000297","DOI":"10.1161\/JAHA.113.000297","article-title":"Enigmatic Ectopic Fat: Prevalence of Nonalcoholic Fatty Pancreas Disease and Its Associated Factors in a Chinese Population","volume":"3","author":"Wang","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lesmana, C.R.A., Pakasi, L.S., Inggriani, S., Aidawati, M.L., and Lesmana, L.A. (2015). Prevalence of Non-Alcoholic Fatty Pancreas Disease (NAFPD) and Its Risk Factors among Adult Medical Check-Up Patients in a Private Hospital: A Large Cross Sectional Study. BMC Gastroenterol., 15.","DOI":"10.1186\/s12876-015-0404-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e11293","DOI":"10.1097\/MD.0000000000011293","article-title":"Prevalence and Factors Associated with Nonalcoholic Fatty Pancreas Disease and Its Severity in China","volume":"97","author":"Weng","year":"2018","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/MPA.0000000000000941","article-title":"Fatty Pancreas: Should We Be Concerned?","volume":"46","author":"Majumder","year":"2017","journal-title":"Pancreas"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/MEG.0000000000002893","article-title":"Prevalence, Clinical Characteristics, and Outcomes of Fatty Pancreas Disease: An Updated Systematic Review and Meta-Analysis","volume":"37","author":"Souza","year":"2025","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1080\/00365521.2024.2333365","article-title":"Intra-Pancreatic Fat Deposition and Its Relation to Obesity: A Magnetic Resonance Imaging Study","volume":"59","author":"Gjela","year":"2024","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2916","DOI":"10.2337\/dc07-0326","article-title":"Pancreatic Fat Content and \u03b2-Cell Function in Men with and without Type 2 Diabetes","volume":"30","author":"Tushuizen","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000505366","article-title":"Nonalcoholic Fatty Pancreas Disease: Clinical Consequences","volume":"38","author":"Dite","year":"2020","journal-title":"Dig. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1016\/j.cgh.2021.09.027","article-title":"Fatty Pancreas Is Independently Associated with Subsequent Diabetes Mellitus Development: A 10-Year Prospective Cohort Study","volume":"20","author":"Chan","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1080\/00365521.2023.2200452","article-title":"Non-Alcoholic Fatty Pancreas Disease and Pancreatic Exocrine Insufficiency: Pilot Study and Systematic Review","volume":"58","author":"Maetzel","year":"2023","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.3748\/wjg.15.1869","article-title":"Clinical Implications of Fatty Pancreas: Correlations between Fatty Pancreas and Metabolic Syndrome","volume":"15","author":"Lee","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.gie.2011.01.015","article-title":"A Prospective Evaluation of Fatty Pancreas by Using EUS","volume":"73","author":"Sepe","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e8060","DOI":"10.1097\/MD.0000000000008060","article-title":"Transabdominal Ultrasonography of the Pancreas Is Superior to That of the Liver for Detection of Ectopic Fat Deposits Resulting from Metabolic Syndrome","volume":"96","author":"Li","year":"2017","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"335","DOI":"10.14366\/usg.21099","article-title":"Hyperechoic Pancreas on Ultrasonography: An Analysis of Its Severity and Clinical Implications","volume":"41","author":"Oh","year":"2022","journal-title":"Ultrasonography"},{"key":"ref_23","first-page":"1229","article-title":"Fatty Pancreas: Linking Pancreas Pathophysiology to Nonalcoholic Fatty Liver Disease","volume":"10","author":"Rugivarodom","year":"2022","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s10620-021-06844-3","article-title":"Pancreatic Steatosis Is Associated with Both Metabolic Syndrome and Pancreatic Stiffness Detected by Ultrasound Elastography","volume":"67","author":"Sezgin","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_25","first-page":"a23899085","article-title":"Pancreatic Ultrasound: An Update of Measurements, Reference Values, and Variations of the Pancreas","volume":"10","author":"Meier","year":"2024","journal-title":"Ultrasound Int. Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1002\/jmri.23741","article-title":"Proton Density Fat-Fraction: A Standardized MR-Based Biomarker of Tissue Fat Concentration","volume":"36","author":"Reeder","year":"2012","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1148\/radiol.2015142254","article-title":"Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging","volume":"279","author":"Yoon","year":"2016","journal-title":"Radiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1148\/radiol.15140446","article-title":"Pancreatic Steatosis Demonstrated at MR Imaging in the General Population: Clinical Relevance","volume":"276","author":"Berthold","year":"2015","journal-title":"Radiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20180941","DOI":"10.1259\/bjr.20180941","article-title":"Quantitative Pancreatic MRI: A Pathology-Based Review","volume":"92","author":"Chouhan","year":"2019","journal-title":"Br. J. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kato, S., Iwasaki, A., Kurita, Y., Arimoto, J., Yamamoto, T., Hasegawa, S., Sato, T., Imajo, K., Hosono, K., and Kobayashi, N. (2019). Three-Dimensional Analysis of Pancreatic Fat by Fat-Water Magnetic Resonance Imaging Provides Detailed Characterization of Pancreatic Steatosis with Improved Reproducibility. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0224921"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Virostko, J., Craddock, R.C., Williams, J.M., Triolo, T.M., Hilmes, M.A., Kang, H., Du, L., Wright, J.J., Kinney, M., and Maki, J.H. (2021). Development of a Standardized MRI Protocol for Pancreas Assessment in Humans. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0256029"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s10334-020-00825-9","article-title":"Low-Level Fat Fraction Quantification at 3 T: Comparative Study of Different Tools for Water-Fat Reconstruction and MR Spectroscopy","volume":"33","author":"Trattnig","year":"2020","journal-title":"Magn. Reson. Mater. Phys. Biol. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"6546","DOI":"10.1007\/s00330-026-12475-x","article-title":"Validation of Magnetic Resonance Imaging for Quantification of Intrapancreatic Fat Deposition Using Phantom and Histologic Comparators: A Systematic Review and Meta-Analysis","volume":"36","author":"Zhang","year":"2026","journal-title":"Eur. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"207","DOI":"10.37015\/AUDT.2025.230059","article-title":"Improved Ultrasound Evaluation Method for Diagnosing Nonalcoholic Fatty Pancreatic Disease: Correlation with MRI mDixon-Quant","volume":"9","author":"Lin","year":"2025","journal-title":"Adv. Ultrasound Diagn. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.mri.2020.07.001","article-title":"Noninvasive Assessment of Abdominal Adipose Tissues and Quantification of Hepatic and Pancreatic Fat Fractions in Type 2 Diabetes Mellitus","volume":"72","author":"Sarma","year":"2020","journal-title":"Magn. Reson. Imaging"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2959\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:26:51Z","timestamp":1789633611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,13]]},"references-count":35,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16182959"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16182959","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,13]]}}}