Abstract: Objective The aim of this study was to investigate the application of multiparametric ultrasound (US) in the assessment of patients with high-risk metabolic associated steatohepatitis (hrMASH). Methods A total of 116 patients with MASH were recruited in our hospital between March 2021 and March 2024, and all underwent liber biopsies and ultrasonography for shear wave elastography (SWE), shear wave dispersion imaging (SWD) and attenuation imaging (ATI) for measurement of liver elasticity modulus, dispersion coefficient and attenuation coefficient. Receiver operating characteristic (ROC) curve was drawn to assess the diagnostic efficacy of the multi-US quantitative parameter combination for hrMASH. Results Of the 116 patients with MASH, liver histo-pathological examination showed that hrMASH in 49 cases (42.2%) and non-hrMASH in 67 cases (57.8%); serum total cholesterol and low-density lipoprotein cholesterol levels in patients with hrMASH were(6.5±1.5)mmol/L and (3.9±0.9)mmol/L, both significantly higher than [(5.8±1.1)mmol/L and (3.1±0.7)mmol/L, respectively, P＜0.05] in those with non-hrMASH; serum alanine aminotransferase and aspartate aminotransferase levels in patients with hrMASH were (60.1±6.8)U/L and (44.6±4.7)U/L, both significantly higher than [(35.5±4.7)U/L and (33.4±3.4)U/L, respectively, P＜0.05] in those with non-hrMASH; liver elastic modulus, frequency dispersion coefficient and attenuation coefficient in patients with hrMASH were (4.8±0.9)kPa, (12.1±2.0)m·s^-1·kHz^-1 and (1.1±0.4)dB·cm^-1·MHz^-1, all much higher than [(4.2±0.5)kPa, (10.4±1.7)m·s^-1·kHz^-1 and (0.8±0.1)dB·cm^-1·MHz^-1, respectively, P＜0.05] in those with non-hrMASH; ROC analysis showed that the AUC was 0.858 (95%CI:0.790-0.927), with sensitivity of 74.6% and specificity of 89.8%, when combination of the three ultrasound parameters was applied for prediction of hrMASH. Conclusion Multiparametric US could help predict hrMASH in specific population, which warrants further clinical investigation.

Key words: Metabolic associated steatohepatitis, High-risk, Elasticity modulus, Dispersion coefficient, Attenuation coefficient, Diagnosis