Reliability of performing ultrasound derived SWE and fat fraction in adult livers

Published:September 07, 2021DOI:


      • List reliability in performing liver ultrasound derived fat fraction (UDFF)
      • List the comparison between conventional pSWE and newly developed auto-pSWE
      • Demonstrating a good reproducibility of newly developed UDFF and auto-pSWE in adult livers



      The aim of the study was to test the reproducibility of performing conventional point shear wave elastography (pSWE), auto-pSWE, and ultrasound derived fat fraction (UDFF) in adult livers.


      The Institutional Review Board approved the study and all participants provided written informed consent. Conventional pSWE (obtaining 10 measurements through 10 acquisitions), auto-pSWE (automatically obtaining 15 measurements by a single acquisition), and UDFF (one measurement obtained by one acquisition) of the liver were prospectively performed in 21 participants (10 men, 11 women, mean age 63y) by senior and junior operators in February-May 2021. Shear wave velocity (SWV, m/s) of the liver was measured by conventional pSWE and auto-pSWE. Intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement were used to test intra-observer repeatability and inter-observer reproducibility in measuring pSWE, auto-pSWE, and UDFF.


      ICC for testing intra-observer repeatability and inter-observer reproducibility in performing pSWE, auto-pSWE, and UDFF was >0.85 (95% confidence interval 0.85-0.99). The mean difference of 95% Bland-Altman limits of agreement was -0.02 (upper 0.09, lower -0.12) and the correlation of SWV measured between conventional pSWE and auto-pSWE methods was strong (r2 = 0.87).


      Our results suggest good repeatability and reproducibility in measuring UDFF and SWV in adult livers. The auto-pSWE has higher reliability, reproducibility and time efficacy in measuring SWV of adult livers when compared to conventional pSWE method.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Younossi Z.M.
        • Koenig A.B.
        • Abdelatif D.
        • Fazel Y.
        • Henry L.
        • Wymer M.
        Global epidemiology of nonalcoholic fatty liver disease: meta-analysis assessment of prevalence, incidence, and outcomes.
        Hepatology. 2016; 64: 73-84
        • Jeon S.K.
        • Lee J.M.
        • Joo I.J.
        • et al.
        Prospective evaluation of hepatic steatosis using ultrasound attenuation imaging in patients with chronic liver disease with magnetic resonance imaging proton density fat fraction as the reference standard.
        Ultrasound Med Biol. 2019; 45: 1407-1416
        • Boyce C.J.
        • Pickhardt P.J.
        • Kim D.H.
        • et al.
        Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT.
        AJR. 2010; 194: 623-628
        • Caussy C.
        • Reeder S.B.
        • Sirlin C.B.
        • Loomba R.
        Non-invasive, quantitative assessment of liver fat by MRI-PDFF as an endpoint inn NASH trials.
        Hepatology. 2018; 68: 763-772
        • Gu J.J.
        • Liu S.S.
        • Du S.X.
        • et al.
        Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis.
        Eur Radiol. 2019; 29: 3564-3573
        • Schwenzer N.F.
        • Springer F.
        • Schraml C.
        • Stefan N.
        • Machann J.
        • Schick F.
        Non-invasive and quantification of liver steatosis by ultrasound, computed tomography, and magnetic resonance.
        J Hepatol. 2009; 51: 433-445
        • Dioguardi B.M.
        • Ronot M.
        • Reizine E.
        • et al.
        Quantification of hepatic steatosis with ultrasound: promising role of attenuation imaging coefficient in a biopsy-proven cohort.
        Eur Radiol. 2020; 30: 2293-2301
        • Moga T.V.
        • Stephan A.M.
        • Pienar C.
        • et al.
        Intra- and inter-observer reproducibility of a 2-D shear wave elastography technique and impact of ultrasound experience in achieving reliable data.
        Ultrasound Med Biol. 2018; 44: 1627-1637
        • Tada T.
        • Nishimura T.
        • Yoshida M.
        • Iijima H.
        Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: new trends and role of ultrasonography.
        J Med Ultrason. 2020; 47: 511-520
        • Yoneda M.
        • Suzuki K.
        • Kato S.
        • et al.
        Noncalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography.
        Radiology. 2010; 256: 640-647
        • Burgio M.D.
        • Imbault M.
        • Ronot M.
        • et al.
        Ultrasonic adaptive sound speed estimation for the diagnosis and quantification of hepatic steatosis: a pilot study.
        Ultraschall Med. 2019; 40: 722-733
        • Aitharaju V.
        • De Silvestri A.
        • Barr R.G.
        Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility.
        Abdom Radiol. 2021 Jul 15; (Online ahead of print)
        • Labyed Y.
        • Milkowski A.
        Novel method for ultrasound-derived fat fraction using an integrated phantom.
        J Ultrasound Med. 2020; 39: 2427-2438
        • Tuthill T.A.
        • Sperry R.H.
        • Parker K.J.
        Deviations from rayleigh statistics in ultrasound speckle.
        Ultrason Imaging. 1988; 10: 81-89
        • Parker K.J.
        Ultrasound attenuation and absorption in liver tissue.
        Ultrasound Med Biol. 1983; 9: 363-369
        • Ferraioli G.
        • Maiocchi L.
        • Savietto G.
        • et al.
        Performance of the attenuation imaging technology in the detection of hepatic steatosis.
        J Ultrasound Med. 22 September 2020; (early view)
        • Lin S.C.
        • Heba E.
        • Wolfson T.
        • et al.
        Noninvasive diagnosis of nonalcoholic fatty liver disease and quantification of liver fat using a new quantitative ultrasound technique.
        Clin Gastroenterol Hepatil. 2015; 13: 1337-1345
        • Han A.
        • Andre M.P.
        • Deiranieh L.
        • et al.
        Repeatability and reproducibility of the ultrasonic attenuation coefficient and backscatter coefficient measured in the right lobe of the liver in adults with known or suspected nonalcoholic fatty liver disease.
        J Ultrasound Med. 2018; 37: 1913-1927
        • Han A.
        • Zhang Y.B.
        • Boehringer A.S.
        • et al.
        Assessment of hepatic steatosis in nonalcoholic fatty liver disease by using quantitative US.
        Radiology. 2020; 295: 106-113
        • Bruce M.
        • Kolokythas O.
        • Ferraioli G.
        • Filice C.
        • O’Donnell M.
        Limitations and artifacts in shear-wave elastography of the liver.
        Biomed Eng Lett. 2017; 7: 81-89
        • Dubinsky T.J.
        • Shah H.U.
        • Erpelding T.N.
        • Sannananja B.
        • Sonneborn R.
        • Zhang M.
        Propagation imaging in the demonstration of common shear wave artifacts.
        J Ultrasound Med. 2018; 38: 1611-1616
        • Fang C.
        • Sidhu P.S.
        Ultrasound-based liver elastography: current results and future perspectives.
        Abdom Radiol. 2020; 45: 3463-3472
        • Barr R.G.
        Shear wave liver elastography.
        Abdom Radiol. 2018; 43: 800-807
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Poul S.S.
        • Parker K.J.
        Fat and fibrosis as confounding factors in viscoelastic measurements of the liver.
        Phys Med Biol. 2021; 66: 1-14
        • Huang Z.
        • Zhou J.
        • Lu X.
        • et al.
        How does liver steatosis affect diagnostic performance of 2-D-SWE.SSI: assessment from aspects of steatosis degree and pathological types.
        Eur Radiol. 2021; 31: 3207-3215
        • Sugimoto K.
        • Moriyasu F.
        • Oshiro H.
        • et al.
        The role of multiparametric US of the liver for the evaluation of nonalcoholic steatohepatitis.
        Radiology. 2020; 296: 532-540
        • Bae J.S.
        • Lee D.H.
        • Lee J.Y.
        • et al.
        Assessment of hepatic steatosis by using attenuation imaging: a quantitative, easy-to-perform ultrasound technique.
        Eur Radiol. 2019; 29: 6499-6507
        • Naganuma H.
        • Ishida H.
        • Uno A.
        • Nagai H.
        • Kuroda H.
        • Ogama M.
        Diagnostic problem in two-dimentional shear wave elastography of the liver.
        World J Radiol. 2020; 12: 76-86