Abstract: Objective The aim of this study was to investigate diagnostic performance ofultrasound-guided attenuation parameter (UGAP)in predicting hepatic steatosis in patients with non-alcoholic fatty liver disease(NAFLD). Methods 91 patients with NAFLD were enrolled in our hospital between January 2023 and September 2024, and all underwent liver biopsy for liver steatosis grading andUGAP for measuring attenuation coefficient(AC). Receiver operating characteristic curve (ROC) and area under the curve (AUC) was adopted to analyze diagnostic efficacy. Results Of 91 patients withNAFLD, liver histo-pathological examination showed liver steatosis S1 grade in 45 cases, S2 in 28 cases and S3 in 18 cases; serum TC, TG, ALT and AST levels in patients with S3 liver steatosis were (6.4±1.3)mmol/L, (3.3±1.0)mmol/L, (78.4±15.2)U/L and (62.9±12.6)U/L, all significantly higher than [(4.7±1.1)mmol/L, (1.8±0.7)mmol/L, (27.1±6.3)U/L and (25.6±5.7)U/L, respectively, P<0.05] in patients with S1 or [(5.6±1.4)mmol/L, (2.6±0.8)mmol/L, (42.5±9.6)U/L and (37.2±7.4)U/L, respectively, P<0.05] in patients with S2, while serum HDL-C level was (0.8±0.3)mmol/L, much lower than [(1.2±0.4)mmol/L, P<0.05] in patients with S1 or [(1.0±0.3)mmol/L, P<0.05] in patients with S2; the AC in patients with S3 was (0.8±0.1)dB/cm/MHz, much greater than [(0.6±0.1) dB/cm/MHz, P<0.05] in patients with S1 or [(0.7±0.1)dB/cm/MHz, P<0.05] in patients with S2; ROC analysis showed that the AUC was 0.854(95% CI:0.772-0.935), with sensitivity (Se) of 82.6% and specificity (Sp) of 88.9%, when AC equal to or greater than 0.7dB/cm/MHz as the cut-off-value in predicting liver steatosis ≥S2, and the AUC was 0.834(95% CI:0.699-0.970), with Se of 77.8% and Sp of 93.2%(P<0.05), when the AC greater than 0.8dB/cm/MHz as the cut-off-value in predicting liver steatosis S3. Conclusion AC obtained by conventional ultrasound has a satisfactory clinical application value in the diagnosis of hepatic steatosis in patients with NAFLD, which might help screening preliminarily.

Key words: Non-alcoholic fatty liver disease, Liver steatosis, Ultrasound attenuation imaging coefficient, Diagnosis