Blood-based fibrosis scores align with liver stiffness measured by two-dimensional shear-wave elastography in type 2 diabetes

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Adults with type 2 diabetes mellitus (T2DM) are at high risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This exploratory cross-sectional analysis examined associations of 18 liver scores, bioimpedance-derived body composition, and three exploratory circulating biomarkers with two-dimensional shear-wave elastography (2D-SWE), shear-wave dispersion (SWD), and attenuation imaging (ATI) in 40 adults with T2DM and suspected liver involvement. Spearman and age- and sex-adjusted partial Spearman correlations were evaluated with false discovery rate (FDR) correction and 10,000-resample bootstrap confidence intervals. Fourteen fibrosis-oriented scores correlated with 2D-SWE after outcome-specific FDR correction; thirteen remained significant across 54 score-ultrasound comparisons. The largest positive coefficient was observed for DiabetesLiver (ρ = 0.527; 95% CI 0.257–0.726), followed by the Fibrosis-4 Index (FIB-4; ρ = 0.516; 95% CI 0.224–0.730). Enhanced Liver Fibrosis (ELF) and LiverRisk correlations were 0.444 (0.153–0.674) and 0.408 (0.076–0.669); broader q ≤ 0.030. ATI correlated with three metabolically weighted scores. No body-composition association survived the broader 75-test correction. No score-SWD or biomarker-ultrasound association met q < 0.05; limited power warrants caution. Moderate associations with liver stiffness do not establish diagnostic equivalence. Findings are consistent with guideline-recommended two-step risk stratification for advanced liver fibrosis in MASLD: FIB-4 followed, when indicated, by liver stiffness measurement or ELF.