Inter-platform reproducibility of ultrasonic attenuation and backscatter coefficients in assessing NAFLD

Aiguo Han, Yingzhen N. Zhang, Andrew S. Boehringer, Michael P. Andre, John W. Erdman, Rohit Loomba, Claude B. Sirlin, William D. O’Brien

Research output: Contribution to journalArticlepeer-review


Objectives: To assess inter-platform reproducibility of ultrasonic attenuation coefficient (AC) and backscatter coefficient (BSC) estimates in adults with known/suspected nonalcoholic fatty liver disease (NAFLD). Methods: This HIPAA-compliant prospective study was approved by an institutional review board; informed consent was obtained. Participants with known/suspected NAFLD were recruited and underwent same-day liver examinations with clinical ultrasound scanner platforms from two manufacturers. Each participant was scanned by the same trained sonographer who performed multiple data acquisitions in the right liver lobe using a lateral intercostal approach. Each data acquisition recorded a B-mode image and the underlying radio frequency (RF) data. AC and BSC were calculated using the reference phantom method. Inter-platform reproducibility was evaluated for AC and log-transformed BSC (logBSC = 10log10BSC) by intraclass correlation coefficient (ICC), Pearson’s correlation, Bland-Altman analysis with computation of limits of agreement (LOAs), and within-subject coefficient of variation (wCV; applicable to AC). Results: Sixty-four participants were enrolled. Mean AC values measured using the two platforms were 0.90 ± 0.13 and 0.94 ± 0.15 dB/cm/MHz while mean logBSC values were − 30.6 ± 5.0 and − 27.9 ± 5.6 dB, respectively. Inter-platform ICC was 0.77 for AC and 0.70 for log-transformed BSC in terms of absolute agreement. Pearson’s correlation coefficient was 0.81 for AC and 0.80 for logBSC. Ninety-five percent LOAs were − 0.21 to 0.13 dB/cm/MHz for AC, and − 9.48 to 3.98 dB for logBSC. The wCV was 7% for AC. Conclusions: Hepatic AC and BSC are reproducible across two different ultrasound platforms in adults with known or suspected NAFLD. Key Points: • Ultrasonic attenuation coefficient and backscatter coefficient are reproducible between two different ultrasound platforms in adults with NAFLD. • This inter-platform reproducibility may qualify quantitative ultrasound biomarkers for generalized clinical application in patients with suspected/known NAFLD.

Original languageEnglish (US)
Pages (from-to)4699-4708
Number of pages10
JournalEuropean Radiology
Issue number9
StatePublished - Sep 1 2019


  • Nonalcoholic fatty liver disease
  • Phantoms, imaging
  • Prospective studies
  • Reproducibility of results
  • Ultrasonography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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