Efficacy of UGAP and 2D-SWE in Metabolic Dysfunction-Associated Steatotic Liver Disease

Overview

This study evaluates the performance and reproducibility of ultrasound-guided attenuation parameter (UGAP) for quantifying hepatic steatosis and two-dimensional shear wave elastography (2D-SWE) for assessing hepatic fibrosis in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD). UGAP demonstrated good-to-excellent accuracy and reproducibility, while 2D-SWE provided valuable fibrosis assessment in the same ultrasound session.

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), affects approximately 30% of the global population and is linked to metabolic dysfunction. MASLD can progress to steatohepatitis and fibrosis, increasing risks of cirrhosis, liver-related complications, and mortality. Liver biopsy remains the reference standard for staging fibrosis and steatosis but is invasive and limited for monitoring. Noninvasive imaging techniques like magnetic resonance elastography and MRI-PDFF are costly and less accessible, making ultrasound-based methods attractive alternatives for clinical practice.

Data Highlights

Key Findings

• UGAP provides quantitative assessment of hepatic steatosis with good-to-excellent diagnostic performance in MASLD patients.
• UGAP measurements showed high intra- and inter-operator reproducibility after dedicated training.
• 2D-SWE effectively quantifies liver stiffness correlating with fibrosis stage in MASLD.
• Both UGAP and 2D-SWE can be performed in the same ultrasound session, facilitating comprehensive liver evaluation.
• Ultrasound-based attenuation metrics offer a noninvasive, accessible alternative to liver biopsy and MRI techniques for monitoring MASLD.

Clinical Implications

UGAP and 2D-SWE can be integrated into routine ultrasound examinations to noninvasively quantify hepatic steatosis and fibrosis in MASLD patients, enabling safer and more frequent monitoring. Their high reproducibility and diagnostic accuracy support their use as practical tools in clinical settings, potentially reducing reliance on invasive liver biopsies and costly MRI-based methods.

Conclusion

Ultrasound-guided attenuation parameter and 2D shear wave elastography are effective, reproducible, and noninvasive modalities for assessing hepatic steatosis and fibrosis in MASLD, offering valuable alternatives for disease evaluation and monitoring.

References

1. EASL-EASD-EASO Clinical Practice Guidelines 2016 -- Management of NAFLD
2. Recent studies on UGAP performance in chronic liver disease 2020-2023
3. FibroScan® and CAP measurement criteria 2019