To Correlate Fat Quantification on Ultrasound Guided Attenuation Parameter With MR Spectroscopy and Mdixon in the Evaluation of Non-Alcoholic Fatty Liver Disease: A Pilot Study

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders worldwide, with increasing prevalence linked to obesity, diabetes, and metabolic syndrome. Accurate quantification of hepatic fat is crucial for diagnosis, staging, and monitoring of the disease. While MR spectroscopy (¹H-MRS) and mDIXON are established non-invasive reference standards for liver fat quantification, they are expensive and not widely accessible. The ultrasound-guided attenuation parameter (UGAP) offers a promising, affordable alternative by quantifying liver fat through tissue attenuation analysis. However, its diagnostic performance and correlation with established MRI-based techniques require further validation. This is the first study that compares two modalities and three techniques: MR Spectroscopy (¹H-MRS) and mDIXON on MRI and UGAP on ultrasound. To correlate the hepatic fat quantification on ultrasound-gui Objective: ded attenuation parameter with MR Spectroscopy (¹H-MRS) and mDIXON in patients with NAFLD. A total of 30 adult patients were Material And Method: evaluated with NAFLD that had been discovered by incidentally on ultrasound. Hepatic fat fraction was measured on (¹H-MRS) and mDIXON using 3.0T MRI Philips scanner. After MRI study, UGAP measurements were obtained using GE LOGIQ FORTIS ultrasound. Twelve valid measurements were averaged. Data were collected to assess the correlation between UGAP fat quantification and MR-based fat quantification techniques. Results: Pearson correlation was used to assess the association between UGAP grading, MR Spectroscopy fat fraction and mDIXON fat fraction. Correlation is significant at the 0.01 level. The ultrasound-guided attenuation parameter showed a strong positive correlation with both MR Spectroscopy and mDIXON results, with a correlation coefficient of 0.869 and 0.897 respectively. Notably, the mDIXON method demonstrated a higher level of agreement with MR Spectroscopy, with a correlation coefficient of 0.892. UGAP shows h Conclusions: igh degree of correlation with MR spectroscopy and mDIXON imaging as a non-invasive method for the evaluation of non-alcoholic fatty liver disease. UGAP has an acceptable accuracy for liver fat quantification. This study highlights that UGAP can be used in isolation, potentially providing a cost-effective and accessible alternative technique to MRI-based techniques in the assessment and monitoring of hepatic steatosis.