Research in recent years has documented the rise of quantitative ultrasound-based examinations (qnUS) for the assessment of liver steatosis. qnUS of interest include continuous attenuation parameters (CAP), backscatter coefficients, and ultrasound envelope statistic parametric imaging. Despite the clear financial and patient-centric benefits of such non-invasive tools, their reliability in defining both the presence and degree of liver steatosis remains unclear.
Clarifying non-invasive tools’ reliability for liver steatosis is crucial as it will inform the diagnosis and management of non-alcoholic fatty liver disease (NAFLD). Patients with NAFLD experience coexistent liver steatosis and fibrosis monitored via non-invasive MRI-PDFF and invasive liver biopsies.
This article aims to provide an overview of qnUS for the assessment of liver steatosis and their potential implementation in clinical settings.
qnUS techniques quantitatively assess liver steatosis with moderate to very good accuracy. While CAP is regularly used in studies for liver steatosis grading and NAFD exclusion, other examinations like B-Mode qnUS Attenuation Techniques (iATT and UGAP) and attenuation imaging (ATI) have been shown to be superior to CAP and non-inferior to MRI-PDFF in the context to diagnosing and grading liver steatosis.
The advantages of qnUS methods lie in the simplicity of their examinations, their non-invasiveness, as well as their reduced times and costs. As liver steatosis is a major medical challenge with a high prevalence and serious, potentially fatal consequences (progression to liver cirrhosis), these advantages are clinically significant. Ultimately, non-invasive tools used alone and especially in combination may greatly facilitate clinical decision-making involving the early detection of liver steatosis and exclusion of NAFLD.