Correlation of steatosis severity (ultrasound grade) with liver fibrosis stage (shear wave elastography) in patients with non-alcoholic fatty liver disease

Abstract

Background and Aim: This study aimed to analyze the correlation between fatty liver grading based on ultrasonography and fibrosis staging using two-dimensional shear wave elastography (2D-SWE) in patients with Non-Alcoholic Fatty Liver Disease (NAFLD). Methods: A cross-sectional study was conducted in the Radiology Department of our hospital from July to October 2025. A total of 52 NAFLD patients who underwent conventional abdominal ultrasonography and 2D-SWE were included. Fatty liver grading was categorized into four groups (grade 0–3) based on echogenicity and visualization of intrahepatic vascular structures. Fibrosis staging was assessed using 2D-SWE according to the Metavir classification (F0–F4). Patient demographic characteristics were recorded from the electronic medical record (EMR). Statistical analyses included descriptive analysis, Chi-square tests to evaluate associations between categorical variables, and correlation analysis to assess the relationship between steatosis and fibrosis severity. Significance was defined as p < 0.05. Results: Of the 52 patients, most were female (55.8%) and aged <46 years (57.7%). Grade 1 steatosis was the most common ultrasonography finding (71.2%), whereas F0–F1 fibrosis predominated on SWE (67.3%). No statistically significant association was observed between fatty liver grading and gender (p = 0.613) or age (p = 0.944). Similarly, fibrosis staging showed no association with gender (p = 0.371) or age (p = 0.687). However, a very strong positive correlation was found between ultrasonography-based steatosis grading and SWE-based fibrosis staging (p < 0.001, r = 0.875), indicating that increasing steatosis levels paralleled increasing fibrosis severity. Conclusions: Fatty liver grading based on ultrasonography demonstrates a very strong correlation with fibrosis staging assessed by 2D-SWE, confirming the clinical relevance of combined ultrasound-based assessment in NAFLD imaging. While age and gender did not influence steatosis or fibrosis severity, direct fibrosis evaluation remains crucial for early risk stratification.

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