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

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

doi:10.47582/jompac.1871085

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

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

Ethical Statement

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

References

Younossi ZM, Razavi H, Sherman M, et al. Addressing the high and rising global burden of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH): from the growing prevalence to Payors' perspective. Aliment Pharmacol Ther. 2025;61(9):1467-1478. doi:10.1111/apt.70020
Tilg H, Petta S, Stefan N, Targher G. Metabolic dysfunction–associated steatotic liver disease in adults. Jama. 2026;335(2):163-174. doi:10.1001/jama.2025.19615
Sun W, Cui H, Li N, et al. Comparison of FIB-4 index, NAFLD fibrosis score and BARD score for prediction of advanced fibrosis in adult patients with non-alcoholic fatty liver disease: A meta-analysis study. Hepatol Res. 2016;46(9):862-870. doi:10.1111/hepr.12647
Henry L, Eberly KE, Shah D, Kumar A, Younossi ZM. Noninvasive tests used in risk stratification of patients with nonalcoholic fatty liver disease. Clin Liver Dis. 2023;27(2):373-395. doi:10.1016/j.cld.2023.01.022
Mozes FE, Lee JA, Vali Y, et al. Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(8):704-713. doi:10.1016/S2468-1253(23)00141-3
Jeon SK, Lee JM, Joo I. Clinical feasibility of quantitative ultrasound imaging for suspected hepatic steatosis: intra- and inter-examiner reliability and correlation with controlled attenuation parameter. Ultrasound Med Biol. 2021;47(3):438-445. doi:10.1016/j.ultrasmedbio. 2020.11.009
Tada T, Kumada T, Toyoda H, et al. Liver stiffness does not affect ultrasound-guided attenuation coefficient measurement in the evaluation of hepatic steatosis. Hepatol Res. 2020;50(2):190-198. doi:10. 1111/hepr.13442
Kumada T, Toyoda H, Ogawa S, et al. Advanced fibrosis leads to overestimation of steatosis with quantitative ultrasound in individuals without hepatic steatosis. Ultrasonography. 2024;43(2):121-131. doi:10. 14366/usg.23194

Details

Primary Language

English

Subjects

Radiology and Organ Imaging

Journal Section

Research Article

Authors

Atiye Cenay Karabörk Kılıç ^*
0000-0002-9980-8397
Türkiye

Halit Nahit Şendur
0000-0003-1690-2538
Türkiye

Emre Aşiret
0009-0000-7558-6200
Türkiye

Cansu Özbaş
0000-0001-7349-8063
Türkiye

Aylin Billur Şendur
0000-0001-9117-4820
Türkiye

Mahinur Cerit
0000-0003-2878-6052
Türkiye

Suna Oktar
0000-0003-0112-9992
Türkiye

Publication Date

March 27, 2026

Submission Date

January 25, 2026

Acceptance Date

February 20, 2026

Published in Issue

Year 2026 Volume: 7 Number: 2

DOI

https://doi.org/10.47582/jompac.1871085

IZ

https://izlik.org/JA36ZR98ZD

Cite

RIS / Bibtex

APA

Karabörk Kılıç, A. C., Şendur, H. N., Aşiret, E., Özbaş, C., Şendur, A. B., Cerit, M., & Oktar, S. (2026). Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease. Journal of Medicine and Palliative Care, 7(2), 220-224. https://doi.org/10.47582/jompac.1871085

AMA

1.Karabörk Kılıç AC, Şendur HN, Aşiret E, et al. Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease. J Med Palliat Care / JOMPAC / jompac. 2026;7(2):220-224. doi:10.47582/jompac.1871085

Chicago

Karabörk Kılıç, Atiye Cenay, Halit Nahit Şendur, Emre Aşiret, et al. 2026. “Exploring the Correlation Between the Fibrosis-4 Score and Quantitative Ultrasonographic Liver Fat Measurements in Metabolic Dysfunction-Associated Steatotic Liver Disease”. Journal of Medicine and Palliative Care 7 (2): 220-24. https://doi.org/10.47582/jompac.1871085.

EndNote

Karabörk Kılıç AC, Şendur HN, Aşiret E, Özbaş C, Şendur AB, Cerit M, Oktar S (March 1, 2026) Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease. Journal of Medicine and Palliative Care 7 2 220–224.

IEEE

[1]A. C. Karabörk Kılıç et al., “Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 2, pp. 220–224, Mar. 2026, doi: 10.47582/jompac.1871085.

ISNAD

Karabörk Kılıç, Atiye Cenay - Şendur, Halit Nahit - Aşiret, Emre - Özbaş, Cansu - Şendur, Aylin Billur - Cerit, Mahinur - Oktar, Suna. “Exploring the Correlation Between the Fibrosis-4 Score and Quantitative Ultrasonographic Liver Fat Measurements in Metabolic Dysfunction-Associated Steatotic Liver Disease”. Journal of Medicine and Palliative Care 7/2 (March 1, 2026): 220-224. https://doi.org/10.47582/jompac.1871085.

JAMA

1.Karabörk Kılıç AC, Şendur HN, Aşiret E, Özbaş C, Şendur AB, Cerit M, Oktar S. Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease. J Med Palliat Care / JOMPAC / jompac. 2026;7:220–224.

MLA

Karabörk Kılıç, Atiye Cenay, et al. “Exploring the Correlation Between the Fibrosis-4 Score and Quantitative Ultrasonographic Liver Fat Measurements in Metabolic Dysfunction-Associated Steatotic Liver Disease”. Journal of Medicine and Palliative Care, vol. 7, no. 2, Mar. 2026, pp. 220-4, doi:10.47582/jompac.1871085.

Vancouver

1.Atiye Cenay Karabörk Kılıç, Halit Nahit Şendur, Emre Aşiret, Cansu Özbaş, Aylin Billur Şendur, Mahinur Cerit, Suna Oktar. Exploring the correlation between the fibrosis-4 score and quantitative ultrasonographic liver fat measurements in metabolic dysfunction-associated steatotic liver disease. J Med Palliat Care / JOMPAC / jompac. 2026 Mar. 1;7(2):220-4. doi:10.47582/jompac.1871085