Comprehensive Ultrasound Imaging for Diagnosing and Monitoring Steatotic Liver Disease

Ultrasound imaging is commonly used for diagnosing steatotic liver disease (SLD), the most common chronic liver disease, with rising prevalence. However, its utility is constrained by variability and insufficient diagnostic performance. Given the hemodynamic impairment associated with SLD, detection of vascular alterations in the SLD state may provide an additional utility to conventional imaging centered on tissue characteristics. Ultrafast Doppler imaging (UFD) provides significantly higher vessel detection sensitivity than conventional Doppler ultrasound imaging, attributable to its ultrafast frame rate. Volumetric acquisition of UFD, achieved through scanning, can enable visualization and quantification of the overall hepatic vascular system. Here, we integrated UFD with attenuation imaging (ATI) and acoustic structure quantification (ASQ), both quantitative ultrasound imaging, to develop a comprehensive hepatic ultrasound imaging system capable of in vivo scanning in rats, enabling longitudinal SLD monitoring. The volumetric vascular images of the liver, obtained via UFD, demonstrated a decrease in the hemodynamic index vessel volume occupancy and an increase in the structural index sum-of-angles metric in the SLD state. This comprehensive ultrasound imaging, which provides both tissue and vascular information, can be used for the diagnosis and monitoring of SLD and may also be applicable to other liver diseases, including alcoholic liver disease, hepatitis B, and cirrhosis.