Ultrasound-derived fat fraction accurately grades steatosis in MASLD against biopsy in dual-center study

Ultrasound-derived fat fraction (UDFF) vs biopsy for steatosis grading in MASLD: cutoffs ≥6%, ≥15%, ≥21% for mild, moderate, severe; training AUROCs 0.966, 0.805, 0.929; externally validated (0.972/0.922, 0.948/0.934, 0.911/0.936).

• Prospective dual-center study of 418 participants with biopsy-confirmed or suspected MASLD (376 Center 1, 42 Center 2).
• UDFF strongly correlated with histopathology (Spearman ρ = 0.724–0.767, p < 0.001); optimal integer cutoffs were ≥6% (S≥1), ≥15% (S≥2), ≥21% (S3).
• A dual-threshold strategy reduced indeterminate cases by 2.8–24.6%; limitation: small number of severe cases and lack of inter-observer data.

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