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Introduction Methods Results Conclusion Globally, B‐mode ultrasound is the most common modality used for the diagnosis of hepatic steatosis. We aimed to assess the correlation between qualitative liver ultrasound parameters, attenuation imaging (ATI) and histopathology‐diagnosed steatosis grade obtained from liver biopsy. Our secondary aim was to examine the interobserver variability of qualitative ultrasound features.A retrospective cohort study was performed which included adult patients (age ≥ 18 years) who had same‐day liver ultrasound, ATI and liver biopsy for grading hepatic steatosis severity between 2018 and 2022. The qualitative US features for hepatic steatosis were independently scored by three radiologists and interobserver variability was examined. Histologic steatosis grade, ATI and qualitative ultrasound parameters were compared.Ninety patients were included; 67% female with a median age of 54 (IQR 39–65) years. The radiologist's overall impression had the highest correlation (very strongly correlated) with histologic steatosis grade (r = 0.82, P < 0.001). ATI coefficient and all qualitative ultrasound B‐mode features except for liver echotexture and focal fat sparing were strongly correlated with histologic steatosis grade (r ≥ 0.70, P < 0.001). Most qualitative ultrasound features had good agreement between observers (Kappa statistic 0.61–1.0, P < 0.001), (Kendall coefficient 0.92, P < 0.001).The examined qualitative ultrasound parameters and ATI had good‐excellent performance for diagnosing clinically significant hepatic steatosis; however, the radiologist's overall impression had the best correlation with histologic steatosis grade. Our findings suggest an ongoing role for qualitative liver ultrasound assessment of hepatic steatosis despite the emergence of newer quantitative measures. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic steatosis duration and severity are risk factors for liver fibrosis and cardiometabolic disease. We assessed the diagnostic accuracy of attenuation imaging (ATI), compared with histologic hepatosteatosis grading in adults with varied suspected liver pathologies. Methods: Liver biopsy was performed on 76 patients (51 women, 25 men) with non‐malignant diffuse parenchymal liver disease, within 4 weeks of multiparametric liver ultrasound including attenuation imaging (ATI). Skin‐liver capsule distance (SCD) and body mass index (BMI) were measured. Histologic steatosis was graded none (S0), mild (S1), moderate (S2) or severe (S3). We compared histology and sonographic parameters. Results: The median patient age was 50.5 (range 18–83) years and BMI 28.9 kg/m2 (interquartile range 24.0–33.3). The distribution of histologic steatosis grade was S0 (44%), S1(17%), S2(30%) and S3(9%). Median ATI value for each biopsy steatosis grade was 0.60 (IQR: 0.52–0.65), 0.65 (IQR: 0.6–0.71), 0.83 (IQR: 0.74–0.90) and 0.90 (IQR: 0.82–1.01) dB/cm/MHz for S0, S1, S2 and S3, respectively. The AUC of ATI for detection of any steatosis (S1‐S3) and moderate to severe steatosis (S2‐S3) was 0.85 (95% CI: 0.75–0.91) and 0.91 (95% CI: 0.83–0.99) with cut‐offs of 0.55 and 0.62 dB/cm/MHz. ATI threshold of 0.74 dB/cm/MHz was able to discriminate between S0‐S1 and S2‐3 with accuracy, CI and kappa statistic of 0.8889, 0.65–0.98 and 0.7534. Conclusion: We found a good correlation between ATI and steatosis grade. The most accurate discrimination was between none to mild (S0‐1) and moderate to severe (S2‐3) steatosis. [ABSTRACT FROM AUTHOR]