Clinical Utility of Multiparametric Ultrasonography in Metabolic Dysfunction-Associated Steatotic Liver Disease: Doppler Ultrasonography, Abdominal Fat Thickness, Shear Wave Measurement, and Attenuation Measurement

Background/Aims: Abdominal Doppler ultrasonography (US), abdominal fat quantification, shear wave measurement (SWM), and attenuation measurement (ATT) are readily applicable for liver disease evaluation. This study assessed their clinical utility in metabolic dysfunction- associated steatotic liver disease (MASLD).Methods: We retrospectively reviewed 459 patients who underwent abdominal US between August 2024 and August 2025. Doppler parameters included portal peak systolic velocity (PPSV), portal end-diastolic velocity (PEDV), portal venous pulsatility index, hepatic vein waveform (HVWF), hepatic artery peak systolic velocity, hepatic artery end-diastolic velocity, and hepatic artery resistive index. Subcutaneous fat (SF) and visceral fat (VF) were measured. Hepatic steatosis and stiffness were assessed using SWM and ATT, respectively, and were compared with FibroScan-derived liver stiffness and controlled attenuation parameter (CAP).Results: Patients with MASLD showed significantly lower PPSV and higher SF, VF, ATT, and CAP than those without MASLD (all p<0.001). When the patients were classified into three groups—MASLD, non-MASLD, and liver cirrhosis—the PPSV was lowest in the MASLD group (p<0.001). HVWF abnormalities were more frequent in patients with cirrhosis than in those without cirrhosis (22.6% vs. 11.0%, p=0.011). SWM and ATT correlated significantly with FibroScan-derived liver stiffness and CAP, respectively (r=0.631 and 0.553, both p<0.001).Conclusions: Doppler US parameters and abdominal fat measurements may be useful for identifying MASLD. SWM and ATT showed significant positive correlations with FibroScan-derived liver stiffness and CAP, respectively, supporting their clinical utility.