TOPLINE:

In a technical note conducted as a part of ongoing research for liver disease prediction, detection, monitoring, and staging, the ultrasound-guided attenuation parameter (UGAP) technology maintained diagnostic accuracy for hepatic steatosis measurement regardless of the breathing phase, even in patients with liver fibrosis who were unable to hold their breath.

METHODOLOGY:

• Researchers prospectively enrolled patients with metabolic dysfunction-associated steatotic liver disease with an MRI proton density fat fraction (PDFF) > 10% or advanced fibrosis, evaluated within the last 12 months along with healthy control individuals, as participants of this study between September 2022 and October 2024.
• Participants were divided into two groups: One group (n = 55) underwent measurements during normal breath-hold, peak-inspiration, and end-expiration phases, whereas another group (n = 37) had an additional measurement during the free breathing or normal breathing phase.
• Measurements were performed on the same day with the body in the supine position using UGAP (performed first), MRI-PDFF, and magnetic resonance elastography; all operators were blinded to the results of each method.
• Diagnostic performance was evaluated using area under the receiver operating characteristic curve (AUC) metrics comparing UGAP results across different breathing phases against MRI-PDFF measurements.

TAKEAWAY:

• In the group with 55 participants, UGAP mean values were different between peak-inspiration and end-expiration phases (P < .001); however, no differences were observed between normal breath-hold and peak-inspiration or end-expiration values (P = .077 and P = .062, respectively).
• In the same group, no significant differences in the diagnostic performance (AUCs) were observed between normal breath-hold and peak-inspiration phases (P = .907), between normal breath-hold and end-expiration phases (P = .818), and between peak-inspiration and end-expiration phases (P = .909).
• In the group with 37 participants, UGAP mean values were different between peak-inspiration and end-expiration phases and peak-inspiration and free breathing phases (P = .023 for both). No significant differences in UGAP mean values were found between normal breath-hold and all tested breathing phases.
• In the same group, diagnostic performance was similar between normal breath-hold and peak-inspiration (P = .689), end-expiration (P = .745), or free breathing (P = .934) phases; between peak-inspiration and end-expiration (P = .937) or free breathing (P = .629) phases; and between end-expiration and free breathing (P = .686) phases.

IN PRACTICE:

"Our technical note shows that steatosis measurements can be performed in patients with inability to hold their breaths using recorded volume sampling, which is valuable clinical information," the authors wrote. "However, more research is needed in this field, for instance evaluation in a larger cohort with different etiologies, steatosis stages, sex and ethnicities," they added.

SOURCE:

This study was led by Marie Byenfeldt, Clinical Department of Radiology in Östersund, Region Jämtland and Härjedalen, Östersund, Sweden. It was published online on December 09, 2025, in the European Journal of Radiology.

LIMITATIONS:

The UGAP technology needs to be validated in a larger cohort with different aetiologies, stages of steatosis, sex, and ethnicities to fully understand its capabilities.

DISCLOSURES:

No funding information was provided for the study. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.