Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease

Year 2026, Volume: 7 Issue: 2, 220 - 224, 27.03.2026

Atiye Cenay Karabörk Kılıç , Halit Nahit Şendur , Emre Aşiret , Cansu Özbaş , Aylin Billur Şendur , Mahinur Cerit , Suna Oktar

https://izlik.org/JA36ZR98ZD

Abstract

Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide. While hepatic steatosis defines the disease, liver fibrosis is the main determinant of prognosis. The fibrosis-4 (FIB-4) score is widely used as a first-line noninvasive tool for fibrosis risk stratification, with a threshold of 1.3 recommended in clinical practice. Quantitative ultrasound techniques, including tissue attenuation imaging (TAI) and tissue scatter imaging (TSI), enable objective assessment of hepatic fat content. This study aimed to investigate the relationship between FIB-4 score and quantitative ultrasound-derived liver fat parameters in patients with MASLD.
Methods: This retrospective, single-center study included 196 patients diagnosed with MASLD who underwent quantitative ultrasound liver fat assessment between January 2021 and April 2023. TAI and TSI measurements were obtained under standardized breath-hold conditions with a 1-7 MHz convex transducer. FIB-4 scores were calculated using routine laboratory parameters, and patients were categorized as FIB-4 <1.3 or ≥1.3. Associations between FIB-4 and quantitative ultrasound parameters were evaluated using Spearman correlation analysis. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of TAI and TSI to discriminate patients with FIB-4 ≥1.3.
Results: The median FIB-4 score was 0.91, and 41 patients (20.9%) had an FIB-4 score ≥1.3. TAI values were significantly lower in patients with FIB-4 ≥1.3 (p=0.002), whereas TSI values did not differ significantly between groups. FIB-4 score showed weak inverse correlations with TAI, TSI, and body-mass index. ROC analysis demonstrated limited discriminative performance for TAI (AUC=0.660), while TSI showed no significant diagnostic value.
Conclusion: Quantitative ultrasound-derived liver fat parameters show weak associations with FIB-4-based fibrosis risk in MASLD, supporting the dissociation between hepatic steatosis and FIB-4-based fibrosis risk and indicating the limited utility of ultrasound fat measurements for fibrosis risk stratification.

Keywords

Metabolic dysfunction-associated steatotic liver disease , liver fibrosis , fibrosis-4 score , ultrasonography , hepatic steatosis

Ethical Statement

The Gazi University Clinical Research Ethics Committee allowed permission (Date: 08.05.2023, Decision No: 400).

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