Fat Content Quantification with US Attenuation Coefficient: Phantom Correlation with MRI Proton Density Fat Fraction

<b>Objective:</b> The aim of this study was to evaluate the consistency and reproducibility of attenuation coefficient (AC) measurements using different commercial ultrasound (US) across via a phantom experiment to investigate the relationship between the AC and MRI-derived proton density fat fraction (MRI-PDFF) values and the conversion equation. <b>Methods:</b> Twelve phantoms containing varying fat proportions (0-100%) were constructed. Phantom ACs were estimated via three US attenuation systems, including attenuation imaging (ATI), ultrasound attenuation analysis (USAT), and the US-guided attenuation parameter (UGAP), along with MRI-PDFF. Agreement among the AC values from the three ultrasonic attenuation systems was evaluated. Linear correlation analysis was used to explore the ACs, fat concentrations of the phantom, and MRI-PDFF measurements, from which a linear conversion formula between the ultrasonic attenuation parameters and the MRI-PDFF was derived. <b>Results:</b> MRI-PDFF and phantom fat concentration measurements appeared with a strong linear correlation (R² = 0.996, <i>p</i> < 0.001). For the three US attenuation parameters, both inter-operator and intra-operator intraclass correlation coefficients (ICCs) ranged from 0.990 to 0.995 and 0.989 to 0.995, respectively. Bland-Altman analysis revealed no significant differences between the above three (all <i>p</i> > 0.05). Significant linear relationships were demonstrated between ultrasound attenuation parameters and phantom fat concentration (r = 0.938-0.986; all <i>p</i> < 0.001), as well as between ultrasound attenuation parameters and MRI-PDFF values (r = 0.922-0.982; all <i>p</i> < 0.001). A conversion formula (fat proportions ≤ 50%) was derived: US (dB/cm/MHz) = 0.501 + 0.012 MRI-PDFF (%). <b>Conclusions:</b> AC across different commercial ultrasound devices demonstrated significant diagnostic value in fat concentrations that appeared good consistency in measuring phantom fat concentration both between and within groups. The linear relationship between AC and MRI-PDFF enables the application of a conversion formula.