Table 3.

Performance with misclassified cases of AC-5M, AC-5A, and AC-3A for detecting S > 0 liver steatosis as defined by MRI-PDFF ≥ 6%.

Parameter	Algorithm (Observations n)	S0 vs. S1–S3
AUROC (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% (44) IQR/5M ≤ 10% (135) IQR/5M ≤ 15% (168) IQR/5M > 15% (14) AC-5A (overall) † SD/5A ≤ 5% (162) SD/5A ≤ 10% (178) SD/5A ≤ 15% (182) SD/5A > 15% (0) AC-3A (overall) † SD/3A ≤ 5% (116) SD/3A ≤ 10% (173) SD/3A ≤ 15% (178) SD/3A > 15% (4)	0.95 (0.92–0.98) 0.97 (0.93–1.00) p = 0.33 * 0.93 (0.89–0.97) p = 0.51 * 0.94 (0.91–0.97) p = 0.89 * 0.96 (0.85–1.00) p = 0.87 * 0.95 (0.92–0.98) p = 0.93 * 0.95 (0.92–0.98) p = 1.00 * 0.95 (0.92–0.98) p = 1.00 * 0.95 (0.92–0.98) p = 0.93 * ---- 0.94 (0.91–0.97) p = 0.66 * 0.92 (0.88–0.97) p = 0.29 * 0.95 (0.92–0.98) p = 1.00 * 0.94 (0.90–0.97) p = 0.67 * 1.00 (1.00–1.00) p < 0.001 *
Sensitivity % (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	88.6 (80.9–94.0) 84.9 (68.1–94.9) 88.6 (80.1–94.4) 89.1 (81.4–94.4) 75.0 (19.4–99.4) 91.4 (84.4–96.0) 91.4 (83.8–96.2) 91.2 (83.9–95.9) 91.4 (84.4–96.0) ---- 83.8 (75.4–90.3) 84.6 (74.7–91.8) 84.8 (76.2–91.3) 83.5 (74.9–90.1) 100 (15.8–100)
Specificity % (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	87.0 (77.4–93.6) 90.9 (58.7–99.8) 80.9 (66.7–90.9) 86.6 (76.0–93.7) 90.0 (55.5–99.8) 84.4 (74.4–91.7) 84.1 (73.3–91.8) 84.2 (74.0–91.6) 84.4 (74.4–91.7) ---- 92.2 (83.8–97.1) 84.2 (68.8–94.0) 91.9 (83.2–97.0) 92.0 (83.4–97.0) 100 (15.8–100)
PPV % (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	90.2 (82.9–95.3) 96.6 (88.2–99.9) 89.7 (81.3–95.2) 90.9 (83.4–95.8) 75.0 (30.1–95.4) 88.9 (81.4–94.1) 88.5 (80.4–94.1) 88.6 (80.9–94.0) 88.9 (81.4–94.1) ---- 93.6 (87.1–97) 91.7 (84.0–95.8) 93.3 (86.6–96.8) 93.5 (86.9–96.9) 100 (15.8–100)
NPV % (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	84.8 (75.0–91.9) 66.7 (38.4–88.2) 79.2 (65.0–89.5) 84.1 (73.3–91.8) 90 (62–98) 87.8 (78.2–94.3) 87.9 (77.5–94.6) 87.7 (77.9–94.2) 87.8 (78.2–94.3) ---- 80.7 (72.9–86.6) 72.7 (60.9–82) 81.9 (73.9–87.9) 80.2 (72.3–86.3) 100 (15.8–100)
LR+ (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	6.82 (3.81–12.21) 9.33 (1.43–60.82) 4.63 (2.56–8.37) 6.63 (3.60–12.23) 7.5 (1.07–52.38) 5.87 (3.48–9.90) 5.73 (3.32–9.89) 5.77 (3.42–9.74) 5.87 (3.48–9.90) ---- 10.76 (4.97–23.3) 5.36 (2.56–11.24) 10.46 (4.84–22.64) 10.44 (4.82–22.59) ----
LR− (95% CI)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	0.13 (0.08–0.23) 0.17 (0.07–0.38) 0.14 (0.08–0.26) 0.13 (0.07–0.22) 0.28 (0.05–1.54) 0.10 (0.05–0.19) 0.10 (0.05–0.20) 0.10 (0.06–0.20) 0.10 (0.05–0.19) ---- 0.18 (0.11–0.27) 0.18 (0.11–0.31) 0.16 (0.10–0.26) 0.18 (0.12–0.28) 0
Total misclassified cases, n (%)	AC-5M (overall) † IQR/5M ≤ 5% IQR/5M ≤ 10% IQR/5M ≤ 15% IQR/5M > 15% ^ AC-5A (overall) † SD/5A ≤ 5% SD/5A ≤ 10% SD/5A ≤ 15% SD/5A > 15% AC-3A (overall) † SD/3A ≤ 5% SD/3A ≤ 10% SD/3A ≤ 15% SD/3A > 15% §	22 (12 FN + 10 FP) (12.1) 6 (5 FN + 1 FP) (13.6) 19 (10 FN + 9 FP) (14.1) 20 (11 FN + 9 FP) (11.9) 2 (1 FN + 1 FP) (14.3) 21 (9 FN + 12 FP) (11.5) 19 (8 FN + 11 FP) (11.7) 21 (9 FN + 12 FP) (11.8) 21 (9 FN + 12 FP) (11.5) ---- 23 (17 FN + 6 FP) (12.6) 18 (12 FN + 6 FP) (15.5) 21 (15 FN + 6 FP) (12.1) 23 (17 FN + 6 FP) (12.9) 0

*, AUROC comparison with AC-5M AUROC; ^†, IQR/M and SD/A were ≤30% for all AC measurements; ^, only 14 individuals had IQR/M > 15%; ^§, only 4 individuals had SD/3A > 15%. AC-5M, attenuation coefficient (median of five measurements); AC-5A, attenuation coefficient (average of five measurements); AC-3A, attenuation coefficient (average of three measurements); dB/cm/MHz, decibel/centimeter/megahertz; CI, confidence interval; FN, false negative; FP, false positive; IQR/M, interquartile range to median ratio; SD/A, standard deviation to average ratio; LR+, positive likelihood ratio; LR, negative likelihood ratio; MRI-PDFF, magnetic resonance imaging proton density fat fraction; NPV, negative predictive value; p, probability of α type I error; PPV, positive predictive value; S, steatosis grade; SD, standard deviation.