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

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