Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers

Ultrasound attenuation imaging (ATI) is a non-invasive method for quantifying hepatic steatosis, offering advantages over the hepatorenal index (HRI). However, its reliability can be influenced by factors such as measurement depth, ROI size, and subcutaneous fat. This paper examines the impact of th...

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Main Authors: Alexander Martin, Oliver Hurni, Catherine Paverd, Olivia Hänni, Lisa Ruby, Thomas Frauenfelder, Florian A. Huber
Format: Article
Language:English
Published: MDPI AG 2025-07-01
Series:Journal of Imaging
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Online Access:https://www.mdpi.com/2313-433X/11/7/229
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author Alexander Martin
Oliver Hurni
Catherine Paverd
Olivia Hänni
Lisa Ruby
Thomas Frauenfelder
Florian A. Huber
author_facet Alexander Martin
Oliver Hurni
Catherine Paverd
Olivia Hänni
Lisa Ruby
Thomas Frauenfelder
Florian A. Huber
author_sort Alexander Martin
collection DOAJ
description Ultrasound attenuation imaging (ATI) is a non-invasive method for quantifying hepatic steatosis, offering advantages over the hepatorenal index (HRI). However, its reliability can be influenced by factors such as measurement depth, ROI size, and subcutaneous fat. This paper examines the impact of these confounders on ATI measurements and discusses diagnostic considerations. In this study, 33 healthy adults underwent liver ultrasound with ATI and HRI protocols. ATI measurements were taken at depths of 2–5 cm below the liver capsule using small and large ROIs. Two operators performed the measurements, and inter-operator variability was assessed. Subcutaneous fat thickness was measured to evaluate its influence on attenuation values. The ATI measurements showed a consistent decrease in attenuation coefficient values with increasing depth, approximately 0.05 dB/cm/MHz. Larger ROI sizes increased measurement variability due to greater anatomical heterogeneity. HRI values correlated weakly with ATI and were influenced by operator technique and subcutaneous fat, the latter accounting for roughly 2.5% of variability. ATI provides a quantitative assessment of hepatic steatosis compared to HRI, although its accuracy can vary depending on the depth and ROI selection. Standardised imaging protocols and AI tools may improve reproducibility and clinical utility, supporting advancements in ultrasound-based liver diagnostics for better patient care.
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institution Kabale University
issn 2313-433X
language English
publishDate 2025-07-01
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series Journal of Imaging
spelling doaj-art-b10372ca67d64d79b1d63a276ab0434f2025-08-20T03:36:21ZengMDPI AGJournal of Imaging2313-433X2025-07-0111722910.3390/jimaging11070229Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy VolunteersAlexander Martin0Oliver Hurni1Catherine Paverd2Olivia Hänni3Lisa Ruby4Thomas Frauenfelder5Florian A. Huber6Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, SwitzerlandInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, SwitzerlandInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, SwitzerlandInstitute of Anesthesiology and Perioperative Medicine, University Hospital Zurich, 8091 Zurich, SwitzerlandInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, SwitzerlandInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, SwitzerlandInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, SwitzerlandUltrasound attenuation imaging (ATI) is a non-invasive method for quantifying hepatic steatosis, offering advantages over the hepatorenal index (HRI). However, its reliability can be influenced by factors such as measurement depth, ROI size, and subcutaneous fat. This paper examines the impact of these confounders on ATI measurements and discusses diagnostic considerations. In this study, 33 healthy adults underwent liver ultrasound with ATI and HRI protocols. ATI measurements were taken at depths of 2–5 cm below the liver capsule using small and large ROIs. Two operators performed the measurements, and inter-operator variability was assessed. Subcutaneous fat thickness was measured to evaluate its influence on attenuation values. The ATI measurements showed a consistent decrease in attenuation coefficient values with increasing depth, approximately 0.05 dB/cm/MHz. Larger ROI sizes increased measurement variability due to greater anatomical heterogeneity. HRI values correlated weakly with ATI and were influenced by operator technique and subcutaneous fat, the latter accounting for roughly 2.5% of variability. ATI provides a quantitative assessment of hepatic steatosis compared to HRI, although its accuracy can vary depending on the depth and ROI selection. Standardised imaging protocols and AI tools may improve reproducibility and clinical utility, supporting advancements in ultrasound-based liver diagnostics for better patient care.https://www.mdpi.com/2313-433X/11/7/229ultrasound attenuation imagingsteatosisMASLDhepatorenal indexliver fat quantificationultrasound
spellingShingle Alexander Martin
Oliver Hurni
Catherine Paverd
Olivia Hänni
Lisa Ruby
Thomas Frauenfelder
Florian A. Huber
Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers
Journal of Imaging
ultrasound attenuation imaging
steatosis
MASLD
hepatorenal index
liver fat quantification
ultrasound
title Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers
title_full Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers
title_fullStr Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers
title_full_unstemmed Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers
title_short Depth-Dependent Variability in Ultrasound Attenuation Imaging for Hepatic Steatosis: A Pilot Study of ATI and HRI in Healthy Volunteers
title_sort depth dependent variability in ultrasound attenuation imaging for hepatic steatosis a pilot study of ati and hri in healthy volunteers
topic ultrasound attenuation imaging
steatosis
MASLD
hepatorenal index
liver fat quantification
ultrasound
url https://www.mdpi.com/2313-433X/11/7/229
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