Non-alcoholic fatty liver disease ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2] Parth Vikram Singh, MBBS[3]

Overview

Ultrasound is helpful in the diagnosis of non-alcoholic fatty liver disease and is the first-line imaging test for diagnosis of hepatic steatosis. Sonographic findings include increased hepatic echogenicity compared with the renal cortex, decreased visibility of intrahepatic vessels, coarsened echotexture of the liver and impaired visualization of the diaphragm and deeper liver tissue. Ultrasonography has a sensitivity of 80% to 89% and specificity of 87% to 90% for detecting moderate to severe steatosis, but sensitivity is less than 50% for mild steatosis when hepatic fat content is less than 20%.[1]

Ultrasound

  • Ultrasound is considered as the first line of imaging choice for NAFLD patients
  • Ultrasound have senstivity of 60-100 and 80-100 % of positive predictive value.
  • Findings on an ultrasound suggestive of non-alcoholic fatty liver disease include:
    • Moderate to high amount of fatty infiltration of liver which is reflected as increased echogenicity and coarsened echotexture of the liver.
    • If steato-hepatitis has progressed to cirrhosis, a nodular liver surface may be present in addition to other fibrotic changes.[2]
  • Ultrasound elastography is another kind of ultrasound that can give qualitative progression of the liver fibrosis.
  • The only limitation of using an ultrasound is that it cannot differentiate between hepatic fibrosis and steatosis.

References

  1. Tilg H, Petta S, Stefan N, Targher G (January 2026). "Metabolic Dysfunction-Associated Steatotic Liver Disease in Adults: A Review". JAMA. 335 (2): 163–174. doi:10.1001/jama.2025.19615. PMID 41212550 Check |pmid= value (help).
  2. Lee DH (2017). "Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification". Clin Mol Hepatol. doi:10.3350/cmh.2017.0042. PMID 28994271.

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