Ultrasonic Adaptive Sound Speed Estimation for the Diagnosis and Quantification of Hepatic Steatosis: A Pilot Study

Purpose To evaluate the ability of a new ultrasound (US) method based on sound speed estimation (SSE) with respect to the detection, quantification, and grading of hepatic steatosis using magnetic resonance (MR) proton density fat fraction (PDFF) as the reference standard and to calculate one US fat index based on the patient's SSE. Materials and Methods This study received local IRB approval. Written informed consent was obtained from patients. We consecutively included N = 50 patients as the training cohort and a further N = 50 as the validation cohort who underwent both SSE and abdominal MR. Hepatic steatosis was classified according to MR-PDFF cutoffs as: S0 <= 6.5 %, S1 6.5 to 16.5 %, S2 16.5 to 22 %, S3 >= 22 %. Receiver operating curve analysis was performed to evaluate the diagnostic performance of SSE in the diagnosis of steatosis (S1-S3). Based on the optimal data fit derived from our study, we proposed a correspondence between the MR-PDFF and a US fat index. Coefficient of determination R2 was used to evaluate fit quality and was considered robust when R2 > 0.6. Results The training and validation cohorts presented mean SSE values of 1.570 +/- 0.026 and 1.568 +/- 0.023 mm/mu s for S0 and 1.521 +/- 0.031 and 1.514 +/- 0.019 mm/mu s for S1-S3 (p < 0.01) patients, respectively. An SSE threshold of <= 1.537 mm/mu s had a sensitivity of 80 % and a specificity of 85.7 % in the diagnosis of steatosis (S1-S3) in the training cohort. Robust correspondence between MR-PDFF and the US fat index was found both for the training (R2 = 0.73) and the validation cohort (R2 = 0.76). Conclusion SSE can be used to detect, quantify and grade liver steatosis and to calculate a US fat index.