Purpose:We aimed to compare the performances of CT, MRI-derived proton density fat fraction (MRI-PDFF), controlled attenuation parameter (CAP), grayscale ultrasound (US), and attenuation imaging (ATI) for the diagnosis of hepatic steatosis (HS).Methods: A total of 120 prospectively recruited patients who underwent hepatic resection between June 2018 and June 2020 were retrospectively analyzed. CT, MRI-PDFF, CAP, grayscale US, and ATI were performed within 3 months before surgery. The diagnostic performances for the diagnosis of HS ≥ 5% and HS > 33% were compared using the area under the curve (AUC) of receiver operating characteristic curves. Histopathologic examination served as the standard of reference for the degree of HS.Results: For detecting HS ≥ 5%, MRI-PDFF (AUC: 0.946) significantly outperformed CT, CAP and grayscale US (AUC: 0.807, 0.829, and 0.761, respectively) (Ps<0.003). ATI (AUC: 0.892) was the second-best following MRI-PDFF and significantly outperformed grayscale US (P=0.001). On pairwise comparison, there was no significant difference between the AUC of ATI and the values of MRI-PDFF, CT or CAP (P=0.133, 0.063 and 0.150, respectively).For detecting HS > 33%, all the modalities provided good diagnostic performances without a significant difference (AUC: 0.887-0.947) (Ps>0.059).
Conclusion:For detecting HS ≥ 5%, MRI-PDFF was the best imaging modality, while ATI outperformed grayscale US. For detecting HS > 33%, all five imaging tools demonstrated good diagnostic performances.
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