Kun Wang

Introduction/ Background: Patients with Chronic Hepatitis B-related Hepatocellular Carcinoma (CHB-HCC) carry substantial risk of postoperative liver failure attributable to hepatic steatosis; accurate non-invasive grading of hepatic steatosis is therefore essential for optimized perioperative management. Liver biopsy is the gold standard but invasive, while conventional imaging has limitations. Controlled Attenuation Parameter (CAP) and Attenuation Imaging (ATI) are novel ultrasound-based modalities for steatosis assessment, but their diagnostic performance in CHB-related HCC candidates for hepatectomy remains understudied, with limited data on ATI’s reproducibility in this specific population. Objectives: This study primarily aimed to evaluate the diagnostic performance of Attenuation Imaging (ATI) in grading hepatic steatosis among hepatitis B virus-related hepatocellular carcinoma (HCC) candidates for hepatectomy, in comparison with the Controlled Attenuation Parameter (CAP). As a secondary objective, the inter-observer reproducibility of ATI measurements was also assessed. Methods: HCC patients with CHB who were scheduled to undergo hepatectomy from January 2022 to January 2025 were prospectively enrolled in this study. All patients underwent ATI and CAP examinations. Steatosis grade, fibrosis stage, and necroinflammatory activity were determined according to histopathology. ATI reproducibility was assessed using Bland-Altman analysis and Intraclass Correlation Coefficients (ICCs). Receiver Operating Characteristic (ROC) analysis was performed to assess the diagnostic performance of ATI and CAP. Results: A total of 164 participants were included. ATI had a higher success rate than CAP (98.0% vs 81.6%). The correlation coefficient between the AC value and the CAP values was 0.714. The correlation coefficients between AC and CAP values and histologically-determined steatosis grade were 0.725 and 0.678, respectively. AC and CAP values differed significantly among patients with varying hepatic steatosis grades. For the prediction of steatosis grade ≥S1 and ≥S2, Attenuation Imaging (ATI) yielded Area Under the Receiver Operating Characteristic curve (AUROC) values of 0.926 and 0.914, with optimal AC cutoffs of 0.69 and 0.76 dB/cm/MHz, respectively. Meanwhile, CAP achieved AUROCs of 0.895 and 0.904 for identifying ≥S1 and ≥S2 steatosis, corresponding to optimal cutoff values of 224 and 240 dB/m, respectively. No statistically significant difference in diagnostic performance was observed between the two modalities (Z = 1.057, 0.220; p = 0.29, 0.83). Multivariate analysis identified steatosis grade and Triglyceride (TG) level as significant determinants of AC values, whereas steatosis grade was the sole independent predictor of CAP measurements. Discussion: We compared ATI and CAP for hepatic steatosis grading in CHB-related HCC patients undergoing hepatectomy, confirming both modalities have good diagnostic performance for steatosis grade prediction, with no statistically significant difference in their AUROCs. Notably, ATI had a higher examination success rate, which is clinically valuable for patients with liver anatomical changes due to CHB and HCC. ATI’s excellent intra- and inter-observer reproducibility supports its reliability for repeated clinical assessments, and the correlation between AC and CAP values validates their consistency in reflecting hepatic fat deposition. The identification of steatosis grade and TG as determinants of AC values provides insights into the physiological factors influencing ATI measurements, while CAP’s sole association with steatosis grade suggests its more specific focus on fat deposition. Compared with CAP, ATI’s integration with B-mode imaging enables targeted sampling of liver parenchyma, avoiding tumor lesions and artifacts, which may contribute to its higher success rate. Limitations of this study include a single-center design, a relatively small sample size of moderate-to-severe steatosis patients, and potential spatial discrepancies between imaging sampling regions and pathological specimens. Conclusion: ATI demonstrates excellent intra- and inter-observer reproducibility and a higher examination success rate than CAP in CHB-related HCC patients, making it a reliable noninvasive modality for preoperative hepatic steatosis grading. While ATI and CAP show comparable diagnostic accuracy for identifying steatosis grade ≥S1 and ≥S2, ATI’s B-mode guidance confers practical clinical advantages for this patient population with altered liver anatomy. As a feasible ultrasound-based technique, ATI can serve as a valuable tool for preoperative screening and dynamic follow-up of hepatic steatosis in CHB-related HCC patients undergoing hepatectomy, aiding in perioperative risk stratification and treatment decision-making. Its association with triglyceride levels also provides a basis for combining clinical biochemical indicators to optimize steatosis assessment in this specific cohort.

Objectives: The aim of this study was to compare the diagnostic performance of attenuation imaging (ATI), shear wave elastography (SWE), and shear wave dispersion (SWD) for detecting and grading hepatic steatosis in patients with metabolic dysfunction associated steatotic liver disease (MASLD). Methods: Sixty-six patients with MASLD confirmed histopathologically and 34 healthy volunteers who were age/sex-matched were prospectively enrolled in this study. ATI, SWE, and SWD examinations were performed. Fibrosis stage, necroinflammatory activity, and steatosis grade were confirmed histopathologically. Steatosis was graded as follows: S0 (66%). We compared the diagnostic performance of ATI, SWE, and SWD for detecting and grading hepatic steatosis. Results: Both attenuation coefficient (AC) and SWD values were significantly different among the different hepatic steatosis, and both were correlated with hepatic steatosis. ATI had better diagnostic performance than SWD for detecting and grading hepatic steatosis. The area under the receiver operating characteristic (ROC) curve of ATI for detecting ≥S1, ≥S2, and =S3 were 0.917 (cut-off value of 0.69 dB/cm/MHz), 0.933 (cut-off value of 0.74 dB/cm/MHz), and 0.870 (cut-off value of 0.82 dB/cm/MHz), respectively. The area under the ROC curve of SWD value was 0.758 (cut-off value of 10.79 m/s/kHz), 0.685 (cut-off value of 12.64 m/s/kHz), and 0.722 (cut-off value of 13.24 m/s/kHz), respectively. Conclusions: ATI technology is a reliable method for detecting and grading hepatic steatosis in patients with MASLD than SWE and SWD. Advances in knowledge: We compared the diagnostic performance of ATI, SWE, SWD for detecting and grading hepatic steatosis in patients with MASLD in order to find the best diagnostic parameters.

Objectives: To investigate the methodology and clinical application of ultrasound attenuation imaging (ATI) and comparative analyze the diagnostic performance of ATI and controlled attenuation parameters (CAP) for detecting and grading hepatic steatosis.Methods: A total of 159 patients with NAFLD were prospectively enrolled. CAP and ATI examinations were performed within a week before proton magnetic resonance spectroscopy (¹H‐MRS). Ten liver attenuation coefficient (AC) measurements by ATI were obtained in each patient. The interclass correlation coefficients (ICCs) of the intraobserver consistencies and the ICCs between the median of the first two through the first nine measurements and all 10 measurements were calculated. The correlations between ¹H‐MRS, CAP, biological data, and ATI were evaluated. The significant factors associated with ATI and the diagnostic performance of ATI and CAP for detecting hepatic steatosis was evaluated.Results: The median value of AC for detecting hepatic steatosis was 0.831 dB/cm/MHz. For the intraobserver consistency of ATI, the ICC was 0.931. Compared with 10 measurements, a minimum of four ATI measurements was required. The correlation of AC with hepatic fat fraction (HFF) was significantly higher than that of CAP (0.603 vs 0.326, P = .0015). The HFF and triglyceride (TG) were the significant factors for the ATI. The area under the receiver operating characteristics (ROC) curves of ATI and CAP were 0.939 and 0.788 for detecting ≥10% hepatic steatosis; 0.751 and 0.572 for detecting >33% hepatic steatosis. The cutoff values of ATI and CAP were 0.697 dB/cm/MHz and 310 dB/m for detecting ≥10% hepatic steatosis; 0.793 dB/cm/MHz and 328 dB/m for detecting >33% hepatic steatosis. The sensitivity of ATI and CAP were 85.92% and 52.11% for detecting ≥10% hepatic steatosis; 87.50% and 82.14% for detecting >33% hepatic steatosis. The specificity of ATI and CAP were 94.12% and 100% for detecting ≥10% hepatic steatosis; 54.37% and 43.69% for detecting >33% hepatic steatosis.Conclusions: ATI technology showed excellent intraobserver consistency and the optimal minimum number of ATI measurements was 4. ATI is a promising noninvasive, quantitative and convenient tool for assessing hepatic steatosis.

Objectives: This study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic parenchyma in patients with liver tumors before resection.Methods: A total of 174 patients with liver tumors were prospectively enrolled. SWE and SWD examinations were performed. Fibrosis stage and necroinflammatory activity were determined histopathologically according to the Scheuer standard. We compared the diagnostic accuracy of SWE and SWD.Results: Both SWE and SWD values of the liver were highly correlated with liver fibrosis stage (P < .05, respectively). Both SWE and SWD values of the liver were moderately correlated with necroinflammatory activity (P < .05, respectively). Both SWE and SWD values of the liver were not correlated with steatosis (P > .05, respectively). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (P < .001, respectively). The area under the receiver operating characteristic (ROC) curve of SWE value was 0.982, 0.977, 0.969, and 0.984 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWE values were 6.9, 7.9, 8.7, and 10.6 kPa for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The area under the ROC curve of SWD value was 0.967, 0.960, 0.925, and 0.954 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWD values were 11.2, 12.0, 13.2, and 16.0 m/s/kHz for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively.Conclusions: SWE and SWD could be noninvasive and accurate for predicting the stage of liver fibrosis in patients with liver tumors before surgery. SWE was more accurate than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4).