Attenuation Based Quantitative Evaluation of Hepatic Steatosis Using US: Current Status and Future Perspective

Hepatic steatosis is a key characteristic of metabolic dysfunction-associated steatotic liver disease and may progress to cirrhosis and end-stage liver disease through metabolic dysfunction-associated steatohepatitis in 10%-30% of patients. Consequently, early detection and accurate assessment are essential. Grayscale US has traditionally been used for evaluating hepatic steatosis; however, its limitations include reduced sensitivity for mild cases and subjective interpretation. In addition to controlled attenuation parameter, two-dimensional attenuation-based techniques have been recently introduced to quantify US beam attenuation for assessing hepatic steatosis, demonstrating high diagnostic accuracy and reproducibility while addressing some of the limitations of grayscale US. To enhance diagnostic precision and reduce measurement variability, the standardization of examination protocols, including measurement processes, is necessary. Additionally, further research is needed to explore the role of a multiparametric approach combining attenuation-based techniques with elastography in predicting disease progression. This review examines the principles, recent research findings, and future perspectives on attenuation-based quantitative evaluation of hepatic steatosis using US.