The presence of fatty liver was evaluated using ultrasonography. Severity was graded as normal, mild, moderate, or severe according to the degree of fat infiltration (16 ). Liver echotexture, attenuation, and visualization of the intrahepatic vessel borders and/or the diaphragm were used as the indices. Liver stiffness was measured by MRE. All MRE examinations were performed on MRE hardware (GE Healthcare, Waukesha, Wisconsin, USA) with a 1.5-T imaging system using a two-dimensional MRE protocol (17 (link)). The acquired MRE images were automatically processed. Liver stiffness was assessed by a radiologist using regions of interest, excluding the vessels. The cut-off values for significant and advanced hepatic fibrosis were set at MRE values of ≥ 3.0 kPa (F2) and ≥ 3.6 kPa (F3), respectively (18 (link)). We used various cut-off values for advanced hepatic fibrosis for sensitivity analysis. The range of advanced fibrosis was defined as MRE values of 3.2–4.0 kPa for sensitivity analysis (19 (link)–23 (link)).
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