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Purpose <p>Attenuation techniques have been developed to quantify liver fat, improving diagnostic accuracy. However, the standardization of measurement methods remains undefined, limiting clinical application. This study evaluated the effect of different region of interest (ROI) settings on the attenuation coefficient (AC) and coefficient of determination (<i>R</i><sup><i>2</i></sup>) in attenuation imaging (ATI).</p> Methods <p>We analyzed 5212 ultrasound examinations performed at our institution. Two periods were compared: early [ROI positioned at twice the subcutaneous thickness; double positioning (DP), 2 × 3&#xa0;cm] and late [ROI placed beneath the multireflection layer; color positioning (CP), 2 × 4&#xa0;cm]. Additionally, AC and <i>R</i><sup><i>2</i></sup> were analyzed in 331 patients with stored raw data across four conditions: DP and CP for positioning, and 2 × 3&#xa0;cm and 2 × 4&#xa0;cm for size, respectively, using Bland–Altman analysis.</p> Results <p>The early and late periods included 2881 and 2331 examinations, respectively. Patient characteristics were comparable. Significant differences were observed in the AC (median, 0.58 vs. 0.56&#xa0;dB/cm/MHz), steatotic liver diagnostic rates based on AC, <i>R</i><sup><i>2</i></sup> (median, 0.87 vs. 0.93), and proportion of <i>R</i><sup><i>2</i></sup> ≥ 0.90. Raw data analysis showed slight differences in AC and <i>R</i><sup><i>2</i></sup> according to ROI position; however, there were significant differences in ROI size (AC: 2 × 3 &gt; 2 × 4; <i>R</i><sup><i>2</i></sup>: 2 × 4 &gt; 2 × 3).</p> Conclusion <p>In ATI, the larger ROI improved <i>R</i><sup><i>2</i></sup>, whereas the smaller ROI yielded higher AC values, suggesting that ROI size affects diagnostic reliability. Standardizing ATI protocols is essential, with uniformity in ROI size being a priority.</p>

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Effect of region of interest settings on diagnostic performance of attenuation imaging in hepatic steatosis

  • 期刊论文

  • 发表日期：

    2026年1月28日

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  • Shingo Tanaka,
  • Noboru Ohba,
  • Nagomi Saito,
  • Kanna Tanaka,
  • Yuka Ishimoto,
  • Kayoko Ochi,
  • Kenji Yasui,
  • Minori Fujita,
  • Kiyoshi Abe,
  • Satoshi Takahashi

摘要

Purpose

Attenuation techniques have been developed to quantify liver fat, improving diagnostic accuracy. However, the standardization of measurement methods remains undefined, limiting clinical application. This study evaluated the effect of different region of interest (ROI) settings on the attenuation coefficient (AC) and coefficient of determination (R2) in attenuation imaging (ATI).

Methods

We analyzed 5212 ultrasound examinations performed at our institution. Two periods were compared: early [ROI positioned at twice the subcutaneous thickness; double positioning (DP), 2 × 3 cm] and late [ROI placed beneath the multireflection layer; color positioning (CP), 2 × 4 cm]. Additionally, AC and R2 were analyzed in 331 patients with stored raw data across four conditions: DP and CP for positioning, and 2 × 3 cm and 2 × 4 cm for size, respectively, using Bland–Altman analysis.

Results

The early and late periods included 2881 and 2331 examinations, respectively. Patient characteristics were comparable. Significant differences were observed in the AC (median, 0.58 vs. 0.56 dB/cm/MHz), steatotic liver diagnostic rates based on AC, R2 (median, 0.87 vs. 0.93), and proportion of R2 ≥ 0.90. Raw data analysis showed slight differences in AC and R2 according to ROI position; however, there were significant differences in ROI size (AC: 2 × 3 > 2 × 4; R2: 2 × 4 > 2 × 3).

Conclusion

In ATI, the larger ROI improved R2, whereas the smaller ROI yielded higher AC values, suggesting that ROI size affects diagnostic reliability. Standardizing ATI protocols is essential, with uniformity in ROI size being a priority.