Is hepatosteatosis overlooked in ultrasound relying only on B-mode? The impact of incorporating the attenuation coefficient into the standard abdominal ultrasound protocol.

Purpose: Metabolic dysfunction-associated steatotic liver disease is currently one of the most common forms of chronic liver disease. This study aimed to assess whether extending the standard abdominal ultrasound protocol with quantitative liver evaluation increased the number of detected cases of liver steatosis. Material and methods: This study was a retrospective cross-sectional comparison of the detectability of liver steatosis in a study group of 108 patients analysed using the attenuation coefficient, in relation to a matched control group assessed qualitatively with B-mode. Results: Quantitative assessment based on the attenuation coefficient detected more patients with liver steatosis than qualitative assessment based on B-mode. With visual assessment in B-mode, we missed a significant number of patients, mainly those with an S1 steatosis grade. Conclusions: The inclusion of quantitative liver evaluation in everyday practice seems justified, despite current problems with selecting the optimal assessment method and the lack of population-specific cut-off values.