Diagnostic performance of liver steatosis analysis and ultrasound-guided attenuation parameter in quantifying hepatic steatosis: a comparative evaluation using controlled attenuation parameter as reference

Background: Accurate, non-invasive quantification of hepatic steatosis is crucial for clinical management. Recently developed ultrasound-guided attenuation techniques, such as Liver Steatosis Analysis (LiSA) and the Ultrasound-Guided Attenuation Parameter (UGAP), integrate real-time B-mode imaging with quantitative measurement, potentially overcoming the limitation of the lack of real-time guidance in the traditional Controlled Attenuation Parameter (CAP). However, direct comparative evidence for their performance in clinical practice remains insufficient. This study aimed to conduct a head-to-head comparison of the diagnostic performance of LiSA and UGAP, using the widely adopted CAP as a clinical reference standard. Methods: This prospective study ultimately included 357 participants. All participants underwent LiSA, UGAP, and CAP examinations during a single visit. Operations followed standardized protocols with strict quality control (IQR