Accuracy of Ultrasound for Fatty Liver Assessment
4 affiliations
- 1Georgetown University School of Medicine, Washington, DC
- 2Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
- 3Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Hyattsville, MD
- 4Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD; Requests for reprints should be addressed to David S. Weisman, Department of Medicine, Medstar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218.
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent, particularly among individuals with obesity and Type 2 diabetes. Early identification of MASLD is critical, yet access to formal imaging is often limited in primary care. Point-of-care ultrasound (POCUS) with the Ultrasound Fatty Liver Index (US-FLI), a semi-quantitative scoring tool, has demonstrated strong diagnostic accuracy but remains underutilized and is rarely included in standard POCUS training. This pilot study aimed to evaluate the diagnostic performance of US-FLI when performed by a novice POCUS user to explore its potential role as a screening tool for MASLD. Methods: In a prospective convenience cohort ( n = 65), US-FLI scores from a novice POCUS user were compared to radiologist-interpreted abdominal imaging. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve were calculated. Results: Fifteen patients (23%) had confirmed fatty liver disease on standard imaging. The novice user achieved a sensitivity of 0.87, specificity of 0.32, positive predictive value of 0.28, and NPV of 0.89. The area under the receiver operating characteristic curve was 0.61 (95% CI: 0.54-0.67). Raising the US-FLI threshold improved specificity but lowered sensitivity: ≥3 balanced sensitivity (0.73) and specificity (0.62), whereas ≥5 maximized specificity (0.96) at the expense of reduced sensitivity (0.27). Conclusions: POCUS using US-FLI may serve as a rapid, noninvasive screening approach with high sensitivity and NPV, suggesting potential utility for ruling out MASLD in primary care settings. Larger studies in more diverse patient populations are needed to further validate these findings.
Related
- Prevalence of Non-Alcoholic Fatty Liver Disease by Ultrasonographic Assessment in Lean Individuals With Diabetes.
- Omics-based Decoding of Metabolic Dysfunction-associated Fatty Liver Disease: From Pathogenesis to Clinical Translation
- Metabolic dysfunction-associated fatty liver disease and long-term kidney function decline: a 16-year population-based cohort study
- Association between the fasting blood glucose to high-density lipoprotein cholesterol ratio and non-alcoholic fatty liver disease in Chinese adults: a secondary analysis
- Role of the Hepatorenal Index in the Detection of HbA1c-Defined Dysglycemia in Patients With Non-alcoholic Fatty Liver Disease: A Cross-Sectional Study
BibTeX
@article{ericawchen2026accuracy,
title = {{Accuracy of Ultrasound for Fatty Liver Assessment}},
author = {Erica W. Chen, BS and Thayse Lozovoy Madsen-Barbosa, MD and Elisha Poddar, MD and Azade Tabaie, PhD and Radhika Vij, MD and David S. Weisman, DO, FACP},
journal = {American Journal of Medicine Open},
year = {2026},
month = sep,
doi = {10.1016/j.ajmo.2026.100144},
url = {https://doi.org/10.1016/j.ajmo.2026.100144},
note = {CC BY},
}
RIS
TY - JOUR
TI - Accuracy of Ultrasound for Fatty Liver Assessment
AU - Erica W. Chen, BS
AU - Thayse Lozovoy Madsen-Barbosa, MD
AU - Elisha Poddar, MD
AU - Azade Tabaie, PhD
AU - Radhika Vij, MD
AU - David S. Weisman, DO, FACP
PY - 2026
DA - 2026/09/30
JO - American Journal of Medicine Open
DO - 10.1016/j.ajmo.2026.100144
UR - https://doi.org/10.1016/j.ajmo.2026.100144
AB - Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent, particularly among individuals with obesity and Type 2 diabetes. Early identification of MASLD is critical, yet access to formal imaging is often limited in primary care. Point-of-care ultrasound (POCUS) with the Ultrasound Fatty Liver Index (US-FLI), a semi-quantitative scoring tool, has demonstrated strong diagnostic accuracy but remains underutilized and is rarely included in standard POCUS training. This pilot study aimed to evaluate the diagnostic performance of US-FLI when performed by a novice POCUS user to explore its potential role as a screening tool for MASLD. Methods: In a prospective convenience cohort ( n = 65), US-FLI scores from a novice POCUS user were compared to radiologist-interpreted abdominal imaging. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve were calculated. Results: Fifteen patients (23%) had confirmed fatty liver disease on standard imaging. The novice user achieved a sensitivity of 0.87, specificity of 0.32, positive predictive value of 0.28, and NPV of 0.89. The area under the receiver operating characteristic curve was 0.61 (95% CI: 0.54-0.67). Raising the US-FLI threshold improved specificity but lowered sensitivity: ≥3 balanced sensitivity (0.73) and specificity (0.62), whereas ≥5 maximized specificity (0.96) at the expense of reduced sensitivity (0.27). Conclusions: POCUS using US-FLI may serve as a rapid, noninvasive screening approach with high sensitivity and NPV, suggesting potential utility for ruling out MASLD in primary care settings. Larger studies in more diverse patient populations are needed to further validate these findings.
SN - 2667-0364
ER -