Quantification of Liver Fat and Fibrosis with Ultrasound: The Expanding Role of Elastography
DOI:
https://doi.org/10.37762/jgmds.13-3.912Keywords:
Elastography, Liver Fibrosis, Ultrasound, Alt, Metabolic Risk FactorsAbstract
ABSTRACT
OBJECTIVES
To assess ultrasound-detected fatty liver grade and elastography-based fibrosis stage among adults undergoing liver ultrasound evaluation and to determine their association with selected clinical and metabolic risk factors.
METHODOLOGY
This descriptive cross-sectional observational study was conducted at the Department of Radiology, MTI Bacha Khan Medical College and Mardan Medical Complex, Mardan, from February 2026 to April 2026. A total of 83 adults undergoing liver ultrasound evaluation were recruited through non-probability consecutive sampling. Demographic, clinical, laboratory, ultrasound, and elastography findings were recorded. Significant fibrosis was defined as fibrosis stage ≥F2. Data were analyzed using SPSS version 25. The chi-square test and Cramér’s V were used to assess unadjusted associations, while binary logistic regression was used to identify independent factors associated with significant fibrosis.
RESULTS
The mean age of participants was 42.1 ± 13.8 years, and 45 (54.2%) were male. Overweight and obesity were observed in 38 (45.8%) and 22 (26.5%) participants, respectively. Grade II fatty liver was the most common ultrasound finding, observed in 39 (47.0%) participants. Significant fibrosis ≥F2 was present in 51 (61.4%) participants. On unadjusted analysis, BMI category, ALT category, and fatty liver grade were significantly associated with significant fibrosis. On multivariate logistic regression, elevated ALT was associated with higher odds of significant fibrosis (AOR = 5.85, 95% CI: 1.12-30.30, p = 0.036). Fatty liver grade was also independently associated with significant fibrosis (AOR = 15.87, 95% CI: 3.47-72.64, p < 0.001). BMI, diabetes mellitus, age group, and gender were not significant after adjustment.
CONCLUSION
Significant fibrosis was common in this hospital-based sample. Elevated ALT and higher fatty liver grade were independently associated with significant fibrosis ≥F2. Ultrasound-detected fatty liver grade and elastography-based fibrosis staging may support non-invasive risk stratification in patients undergoing liver evaluation.
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D'Hondt A, Rubesova E, Xie H, Shamdasani V, Barth RA. Liver fat quantification by ultrasound in children: a prospective study. AJR Am J Roentgenol. 2021;217(4):996-1006. https://doi.org/10.2214/AJR.20.23828 PMID: 34081531 DOI: https://doi.org/10.2214/AJR.20.24874
Pirmoazen AM, Khurana A, El Kaffas A, Kamaya A. Quantitative ultrasound approaches for diagnosis and monitoring hepatic steatosis in non-alcoholic fatty liver disease. Theranostics. 2020;10(9):4277-89. https://doi.org/10.7150/thno.42317 PMID: 32292511 DOI: https://doi.org/10.7150/thno.40249
Jesper D, Klett D, Schellhaas B, Pfeifer L, Leppkes M, Waldner M, et al. Ultrasound-based attenuation imaging for non-invasive quantification of liver fat: a pilot study on feasibility and interobserver variability. IEEE J Transl Eng Health Med. 2020;8:1800119. https://doi.org/10.1109/JTEHM.2020.2989387 PMID: 32411834 DOI: https://doi.org/10.1109/JTEHM.2020.3001488
Han A, Byra M, Heba E, Andre MP, Erdman JW, Loomba R, et al. Non-invasive diagnosis of non-alcoholic fatty liver disease using radiofrequency ultrasound data and convolutional neural networks. Radiology. 2020;295(2):342-50. https://doi.org/10.1148/radiol.2020191452 PMID: 32097033 DOI: https://doi.org/10.1148/radiol.2020191160
Fetzer DT, Pierce TT, Robbin ML, Cloutier G, Mufti A, Hall TJ, et al. US quantification of liver fat: past, present, and future. Radiographics. 2023;43(7):e220178. https://doi.org/10.1148/rg.220178 PMID: 37358889 DOI: https://doi.org/10.1148/rg.220178
Ferraioli G, Kumar V, Ozturk A, Nam K, de Korte CL, Barr RG. US attenuation for liver fat quantification: an AIUM-RSNA QIBA initiative. Radiology. 2022;302(3):495-506. https://doi.org/10.1148/radiol.210774 PMID: 34995068 DOI: https://doi.org/10.1148/radiol.210736
Bozic D, Podrug K, Mikolasevic I, Grgurevic I. Ultrasound methods for assessment of liver steatosis: a critical appraisal. Diagnostics (Basel). 2022;12(10):2287. https://doi.org/10.3390/diagnostics12102287 PMID: 36292249 DOI: https://doi.org/10.3390/diagnostics12102287
Destrempes F, Gesnik M, Chayer B, Roy-Cardinal MH, Olivié D, Giard JM, et al. Quantitative ultrasound, elastography, and machine learning for assessment of steatosis and fibrosis. PLoS One. 2022;17(1):e0262291. https://doi.org/10.1371/journal.pone.0262291 PMID: 35025838 DOI: https://doi.org/10.1371/journal.pone.0262291
Kavvadas D, Rafailidis V, Liakos A, Sinakos E, Partovi S, Papamitsou T, et al. Quantitative ultrasound for hepatic steatosis: a systematic review. Diagnostics (Basel). 2025;15(20):2640. https://doi.org/10.3390/diagnostics15202640 (PMID pending) DOI: https://doi.org/10.3390/diagnostics15202640
Shabbir A, Abbas Z, Khatoon A, Mirza TJA. Role of alanine transaminase and transient elastography in categorising non-alcoholic fatty liver disease subgroups. J Coll Physicians Surg Pak. 2024;34(6):718-25. (DOI/PMID not indexed) DOI: https://doi.org/10.29271/jcpsp.2024.01.22
Arun Kumar D, Kumar S, Rajagopal R, Ramesh R, M M. Non-invasive assessment of liver fibrosis using shear wave elastography in type 2 diabetes mellitus with NAFLD. Cureus. 2024;16(10):e72471. https://doi.org/10.7759/cureus.72471 PMID: 39428177 DOI: https://doi.org/10.7759/cureus.72471
Villani R, Lupo P, Sangineto M, Romano A, Serviddio G. Liver ultrasound elastography in non-alcoholic fatty liver disease: a state-of-the-art summary. Diagnostics (Basel). 2023;13:1236. https://doi.org/10.3390/diagnostics13071236 PMID: 37046231. DOI: https://doi.org/10.3390/diagnostics13071236
Liguori A, Esposto G, Ainora ME, Mignini I, Borriello R, Galasso L, et al. Liver elastography for fibrosis stratification in MASLD: comparison of three techniques. Biomedicines. 2025;13(1):95. https://doi.org/10.3390/biomedicines13010095 (PMID pending) DOI: https://doi.org/10.3390/biomedicines13010138
Eltony HAR, Kasem G, Elsharaby RM, Badawi R, Helal EM. Non-invasive detection of fibrosis in NAFLD using serum MFAP4 and transient elastography. Egypt Liver J. 2025;15(1):34. https://doi.org/10.1186/s43066-025-00340-0 (PMID pending) DOI: https://doi.org/10.1186/s43066-025-00439-7
Jahani P, Fattahi MR, Neydavoodi M. Correlation of Fibroscan with liver elastography and liver enzymes in fatty liver disease. J Kermanshah Univ Med Sci. 2025;29(1). (DOI/PMID not indexed) DOI: https://doi.org/10.5812/jkums-142386
Cormack JM, Lee HO, Chao YH, Kim K, Behari J. Focused shear wave elastography for liver fibrosis in MASLD. Gastro Hep Adv. 2026;5(3):100855. https://doi.org/10.1016/j.gastha.2025.100855 (PMID pending) DOI: https://doi.org/10.1016/j.gastha.2025.100855
Malik N, Malik G, Rauf M, Basit A, Aftab S, Malik AK. Liver stiffness distribution in Pakistani adults assessed by shear wave elastography. Ann PIMS SZABMU. 2025;21(2):490-5 DOI: https://doi.org/10.48036/apims.v21i2.1518
Seneviratne N, Fang C, Sidhu PS. Ultrasound-based hepatic fat quantification: current status and future directions. Clin Radiol. 2023;78(3):187-200. https://doi.org/10.1016/j.crad.2022.10.019 PMID: 36470653 DOI: https://doi.org/10.1016/j.crad.2022.10.003
De Robertis R, Spoto F, Autelitano D, Guagenti D, Olivieri A, Zanutto P, et al. Ultrasound-derived fat fraction for detection of hepatic steatosis. Radiol Med. 2023;128(10):1174-80. https://doi.org/10.1007/s11547-023-01682-z PMID: 37561187 DOI: https://doi.org/10.1007/s11547-023-01693-8
Nakamura Y, Hirooka M, Koizumi Y, Yano R, Imai Y, Watanabe T, et al. Diagnostic accuracy of ultrasound-derived fat fraction for hepatic steatosis. J Med Ultrason (2001). 2025;52(1):85-94. https://doi.org/10.1007/s10396-024-01437-5 (PMID pending) DOI: https://doi.org/10.1007/s10396-024-01472-6
Li B, Tai DI, Yan K, Chen YC, Chen CJ, Huang SF, et al. Quantitative scoring of liver steatosis from ultrasound images via deep learning. World J Gastroenterol. 2022;28(22):2494-508. https://doi.org/10.3748/wjg.v28.i22.2494 PMID: 35774861 DOI: https://doi.org/10.3748/wjg.v28.i22.2494
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Copyright (c) 2026 Zubair Janan Orakzai, Laila Khan, Hina Baig, Muhammad Sadiq
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