Modern ultrasound techniques for diagnosing liver steatosis and fibrosis: A systematic review with a focus on biopsy comparison

Table 11 Diagnostic efficacy of ultrasound techniques (area under the receiver operating characteristic curves for steatosis detection)

Ref.	Number of patients	Disease	Diagnostic method	Steatosis stage	AUROC (CI)	Assessment
Nogami et al[36]	163	NAFLD	VCTE (CAP)	≥ S1	0.89 (0.73-0.95)	Good
				S2	0.77 (0.82-0.82)	Acceptable
				S3	0.69 (0.75-0.75)	Unacceptable
Liu et al[59]	100	NAFLD	ATI	S ≥ 1	0.762	Acceptable
				S ≥ 2	0.774	Acceptable
				S ≥ 3	0.784	Acceptable
			SWE	S ≥ 1	0.764	Acceptable
				S ≥ 2	0.783	Acceptable
				S ≥ 3	0.802	Good
Qu et al[60]	237	NAFLD	UAP	S1	0.88	Good
				S2	0.93	Excellent
				S3	0.88	Good
Zhao et al[65]	34	MAFLD	NLV	S ≥ 1	0.875 (0.716-0.963)	Good
				S ≥ 2	0.735 (0.556-0.871)	Acceptable
				S ≥ 3	0.583 (0.402-0.749)	Unacceptable
			NLV-SD	S ≥ 1	0.900 (0.748-0.976)	Good
				S ≥ 2	0.745 (0.567-0.878)	Acceptable
				S ≥ 3	0.603 (0.422-0.766)	Unacceptable
Kjaergaard et al[57]	137	ALD/NAFLD	B-mode ratio	S ≥ 1	0.79 (0.70-0.88)	Acceptable
				S ≥ 2	0.76 (0.66-0.85)	Acceptable
				S ≥ 3	0.74 (0.62-0.86)	Acceptable
Zhou et al[64]	139	NAFLD	2D-SWE	Steatohepatitis	0.88	Good
Yazdani et al[61]	49	NAFLD	SWA	S0 vs ≥ S1	0.99	Excellent
				≤ S1 vs ≥ S2	0.98	Excellent
				≤ S2 vs S3	0.93	Excellent
Yu et al[62]	85	MAFLD	CAP (FibroTouch)	S ≥ S1	0.84 (0.67-1.01)	Good
				S ≥ S2	0.88 (0.81-0.95)	Good
				S = S3	0.89 (0.82-0.95)	Good
Hsu et al[56]	28	CLD	ATI	S ≥ 1	0.97 (0.83-1.00)	Acceptable
				S ≥ 2	0.99 (0.86-1.00)	Acceptable
				S = 3	0.97 (0.82-1.00)	Acceptable
Kim et al[67]	60	NASH	HRI	≥ S2	0.871 (0.783-0.956)	Good
				≥ S3	0.851 (0.735-0.930)	Good
Kuroda et al[58]	202	NAFLD	2D-SWE + UGAP	≥ S1	0.89 (P < 0.05)	Good
				≥ S2	0.91 (P < 0.05)	Excellent
				S3	0.92 (P < 0.05)	Excellent
Welman et al[63]	76	Not specified or mixed	ATI	S1-S3	0.85 (0.75-0.91)	Good
				S2-S3	0.91 (0.83-0.99)	Excellent
				S0-S1 vs S2-S3	0.89 (0.65-0.98)	Good

AUROC: Area under the receiver operating characteristic curve; NAFLD: Nonalcoholic fatty liver disease; VCTE: Vibration-controlled transient elastography; CAP: Controlled attenuation parameter; ATI: Attenuation imaging; SWE: Shear wave elastography; UAP: Ultrasound attenuation parameter; MAFLD: Metabolic-associated fatty liver disease; NLV: Normalized local variance; NLV-SD: Standard deviation of normalized local variance; ALD: Alcoholic liver disease; SWA: Shear wave attenuation; NASH: Nonalcoholic steatohepatitis; HRI: Hepatic steatosis or fibrosis-related index; UGAP: Ultrasound-guided attenuation parameter.