{ "abstract": "Background/Objectives: The ultrasound-guided attenuation parameter (UGAP) is conventionally measured at a 4 cm start depth from the skin with a 4 cm region of interest (ROI), whereas 2024 World Federation for Ultrasound in Medicine and Biology (WFUMB) guidance recommends 2 cm from the liver capsule with a 3 cm ROI. We compared these two ROI configurations, applied to the same archived acquisitions, against MRI-derived proton density fat fraction (MRI-PDFF). Methods: This retrospective study included 565 patients with chronic liver disease from four of six participating Japanese centers at which raw data had been stored. Conventional UGAP was measured in real time; WFUMB-based values were calculated retrospectively from the same acquisitions, without real-time operator optimization. Performance was assessed by receiver operating characteristic analysis and the Obuchowski index, with integrated discrimination improvement (IDI) and net reclassification improvement (NRI) as secondary analyses. Results: Areas under the curve did not differ significantly at any threshold (≥S1: 0.92 [95% CI: 0.90–0.94] vs. 0.92 [0.89–0.94]; p = 0.07–0.23). Conventional UGAP correlated slightly more strongly with MRI-PDFF (ρ = 0.83 vs. 0.81; Δρ = 0.02; p < 0.01) and had a higher Obuchowski index (0.92 vs. 0.91; p = 0.04); both differences were statistically significant but of doubtful clinical relevance, and secondary IDI/NRI analyses were directionally consistent but imprecise. Body mass index was the strongest independent predictor of the inter-protocol difference. Conclusions: Neither ROI configuration showed a clinically meaningful advantage on this single-vendor platform. Small differences favoring the manufacturer-optimized configuration were not uniform across centers and may largely reflect acquisition asymmetry. No equivalence margin was prespecified, so these data show no demonstrable advantage for either configuration rather than establishing equivalence and require confirmation in a prospective paired study.", "abstract_shown": true, "affiliations": [ "Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan", "Ultrasound General Imaging, GE HealthCare, Hino 191-8503, Japan", "Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki 503-8502, Japan", "Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan", "Department of Gastroenterology, Nayoro City General Hospital, Nayoro 096-8511, Japan", "Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-8402, Japan", "Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima 734-8551, Japan", "Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino 180-8610, Japan", "Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan", "Department of Nursing, Gifu Kyoritsu University, Ogaki 503-8550, Japan" ], "article_type": null, "arxiv": null, "author_total": 19, "authors": [ { "affs": [ 0 ], "name": "Hidekatsu Kuroda", "orcid": "0000-0002-1471-1087" }, { "affs": [ 1 ], "name": "Takuma Oguri" }, { "affs": [ 1 ], "name": "Naohisa Kamiyama" }, { "affs": [ 2 ], "name": "Hidenori Toyoda", "orcid": "0000-0002-1652-6168" }, { "affs": [ 2 ], "name": "Satoshi Yasuda" }, { "affs": [ 3 ], "name": "Kento Imajo", "orcid": "0000-0002-1931-6326" }, { "affs": [ 4 ], "name": "Yasuaki Suzuki", "orcid": "0000-0001-7081-5625" }, { "affs": [ 5 ], "name": "Katsutoshi Sugimoto", "orcid": "0000-0001-6271-7806" }, { "affs": [ 6 ], "name": "Tomoyuki Akita" }, { "affs": [ 6 ], "name": "Junko Tanaka" }, { "affs": [ 7 ], "name": "Yutaka Yasui", "orcid": "0000-0002-6117-4990" }, { "affs": [ 7 ], "name": "Masayuki Kurosaki", "orcid": "0000-0001-7016-8931" }, { "affs": [ 7 ], "name": "Namiki Izumi" }, { "affs": [ 8 ], "name": "Atsushi Nakajima", "orcid": "0000-0002-6263-1436" }, { "affs": [ 0 ], "name": "Yudai Fujiwara" }, { "affs": [ 0 ], "name": "Tamami Abe" }, { "affs": [ 0 ], "name": "Keisuke Kakisaka", "orcid": "0000-0001-9627-138X" }, { "affs": [ 0 ], "name": "Takayuki Matsumoto" }, { "affs": [ 9 ], "name": "Takashi Kumada", "orcid": "0000-0003-2211-495X" } ], "bibtex": "https://research.draconitic.com/paper/62cfjgejfcp3y.bib", "cited_by": 0, "doi": "10.3390/jcm15218373", "fulltext_url": null, "id": "62cfjgejfcp3y", "issns": [ "2077-0383" ], "landing_url": "https://www.mdpi.com/2077-0383/15/21/8373", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2713|Liver Disease Diagnosis and Treatment" ] ], "openalex": "W7223861725", "pdf_url": null, "pmcid": null, "pmid": null, "published": "2026-10-27", "publisher": "MDPI AG", "ris": "https://research.draconitic.com/paper/62cfjgejfcp3y.ris", "sources": [ { "first_seen": "2026-10-30T12:20:01Z", "native_id": "10.3390/jcm15218373", "source": "crossref", "url": "https://www.mdpi.com/2077-0383/15/21/8373" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2713|Liver Disease Diagnosis and Treatment", "subfield": "epidemiology-public-health" } ], "title": "WFUMB-Recommended Versus Manufacturer-Optimized Protocols for Ultrasound-Guided Attenuation Parameter in Hepatic Steatosis Assessment: A Retrospective Single-Vendor Multicenter Study", "title_text": "WFUMB-Recommended Versus Manufacturer-Optimized Protocols for Ultrasound-Guided Attenuation Parameter in Hepatic Steatosis Assessment: A Retrospective Single-Vendor Multicenter Study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:01Z", "url": "https://research.draconitic.com/paper/62cfjgejfcp3y", "venue": "Journal of Clinical Medicine", "versions": [] }