WFUMB-Recommended Versus Manufacturer-Optimized Protocols for Ultrasound-Guided Attenuation Parameter in Hepatic Steatosis Assessment: A Retrospective Single-Vendor Multicenter Study
10 affiliations
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
- 2Ultrasound General Imaging, GE HealthCare, Hino 191-8503, Japan
- 3Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki 503-8502, Japan
- 4Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
- 5Department of Gastroenterology, Nayoro City General Hospital, Nayoro 096-8511, Japan
- 6Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-8402, Japan
- 7Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima 734-8551, Japan
- 8Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino 180-8610, Japan
- 9Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
- 10Department of Nursing, Gifu Kyoritsu University, Ogaki 503-8550, Japan
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.
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BibTeX
@article{kuroda2026wfumbrecommended,
title = {{WFUMB-Recommended Versus Manufacturer-Optimized Protocols for Ultrasound-Guided Attenuation Parameter in Hepatic Steatosis Assessment: A Retrospective Single-Vendor Multicenter Study}},
author = {Hidekatsu Kuroda and Takuma Oguri and Naohisa Kamiyama and Hidenori Toyoda and Satoshi Yasuda and Kento Imajo and Yasuaki Suzuki and Katsutoshi Sugimoto and Tomoyuki Akita and Junko Tanaka and Yutaka Yasui and Masayuki Kurosaki and Namiki Izumi and Atsushi Nakajima and Yudai Fujiwara and Tamami Abe and Keisuke Kakisaka and Takayuki Matsumoto and Takashi Kumada},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218373},
url = {https://www.mdpi.com/2077-0383/15/21/8373},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - WFUMB-Recommended Versus Manufacturer-Optimized Protocols for Ultrasound-Guided Attenuation Parameter in Hepatic Steatosis Assessment: A Retrospective Single-Vendor Multicenter Study
AU - Hidekatsu Kuroda
AU - Takuma Oguri
AU - Naohisa Kamiyama
AU - Hidenori Toyoda
AU - Satoshi Yasuda
AU - Kento Imajo
AU - Yasuaki Suzuki
AU - Katsutoshi Sugimoto
AU - Tomoyuki Akita
AU - Junko Tanaka
AU - Yutaka Yasui
AU - Masayuki Kurosaki
AU - Namiki Izumi
AU - Atsushi Nakajima
AU - Yudai Fujiwara
AU - Tamami Abe
AU - Keisuke Kakisaka
AU - Takayuki Matsumoto
AU - Takashi Kumada
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218373
UR - https://www.mdpi.com/2077-0383/15/21/8373
AB - 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.
SN - 2077-0383
ER -