Quantitative liver ultrasound: current status and challenges

Ultrasound is the most widely used imaging modality for liver evaluation because it is accessible, portable, affordable, and repeatable. Quantitative liver ultrasound should therefore be understood not as a single technology, but as a set of biomarker strategies at different stages of development. Ultrasound elastography is the most mature component of this field and has been incorporated into noninvasive pathways for fibrosis assessment. Ultrasound-based liver fat quantification is also advancing rapidly through attenuation, backscatter, and radiofrequency-based techniques. A newer area of investigation involves the evaluation of viscoelasticity and inflammatory activity using shear-wave dispersion and related biomarkers, particularly in metabolic dysfunction-associated steatotic liver disease. The future value of quantitative liver ultrasound will depend on integrating multiple parameters to support clinical triage, monitoring, and, increasingly, treatment decision-making.