Ultrasound Shear Wave Elastography for Liver Stiffness and Attenuation Imaging for Liver Steatosis in Patients With Metabolic Dysfunction-Associated Fatty Liver Disease

Background:Metabolic dysfunction-associated fatty liver disease (MAFLD) is a prevalent chronic liver condition.Non-invasive assessment of hepatic steatosis and liver stiffness using attenuation imaging (ATI) and shear wave elastography (SWE) has become increasingly important in clinical practice.However, the association between ATI-defined steatosis grades and SWE-based liver stiffness categories in patients with MAFLD remains unclear.Therefore, this study aimed to investigate the association between ATI-based steatosis severity and SWE-based stiffness category in MAFLD. Material/Methods:A total of 739 consecutive patients with MAFLD who underwent both ATI and SWE examinations between December 2022 and October 2025 were retrospectively enrolled.Hepatic steatosis was graded using ATI (S0-S3), and liver stiffness was categorized using SWE according to established clinical cut-off values.Descriptive statistics, Spearman correlation analysis, and the Fisher-Freeman-Halton exact test were performed to evaluate the association between ATI and SWE measurements and categories. Results:Both ATI and SWE measurements showed non-normal distributions.A weak but statistically significant positive correlation was observed between ATI and SWE values (Spearman's R = 0.097, P = 0.008), whereas Pearson correlation did not show a statistically significant linear association (R = 0.066, P = 0.073).The Fisher-Freeman-Halton exact test showed no statistically significant association between ATI-defined steatosis grades and SWEbased liver stiffness categories (P = 0.063), with a small effect size (Cramér's V = 0.083).Notably, most patients in the indeterminate liver stiffness category were classified as having S2 or S3 steatosis.Conclusions:ATI and SWE measurements showed a weak positive association in patients with MAFLD, whereas no significant association was found between ATI steatosis grades and SWE stiffness categories.