Abstract: Objective The aim of this study was to investigate diagnostic efficacy of quantitative ultrasound (QUS) technology in predicting hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods 117 patients with NAFLD were enrolled in our hospital between March 2024 and August 2025, and all received liver biopsies and QUS for attenuation coefficient at tissue attenuation imaging (AC-TAI) and scatter-distribution coefficient at tissue scatter-distribution imaging (SC-TSI). Receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the diagnostic performance. Results Of the 117 patients with NAFLD, liver histo-pathological examination found mild hepatic steatosis in 48 cases, moderate hepatic steatosis in 40 cases and severe hepatic steatosis in 29 cases; serum triglyceride level in patients with severe hepatic steatosis was (2.1±0.9) mmol/L, significantly higher than [(1.8±0.7) mmol/L, P<0.05] in patients with moderate hepatic steatosis or [(1.6±0.6) mmol/L, P<0.05] in patients with mild hepatic steatosis, and body mass index was (28.9±3.3) kg/m² , significantly higher than [(27.3±3.5) kg/m², P<0.05] in patients with moderate or [(26.1±2.8) kg/m², P<0.05] in patients with mild hepatic steatosis; AC-TAI and SC-TSI in patients with severe hepatic steatosis were (1.1±0.2) dB/cm/MHz and (96.9±9.4), both significantly higher than in those with moderate hepatic steatosis [(0.9±0.2) dB/cm/MHz and (90.3±4.8), respectively, P<0.05] or [(0.8±0.1) dB/cm/MHz and (81.1±6.3), respectively, P<0.05] in those with mild hepatic steatosis; ROC curve analysis showed that the AUC was 0.908 (95% CI: 0.852-0.963), when AC-TAI combined with SC-TSI in predicting severe hepatic steatosis in NAFLD patients, with sensitivity much superior to any parameter did alone. Conclusion Application of AC-TAI and SC-TSI based on QUS technology have certain diagnostic efficacy on hepatic steatosis grading in patients with NAFLD, which might provide a reference for clinical evaluation.

Key words: Non-alcoholic fatty liver disease, Hepatic steatosis, Quantitative ultrasound, Attenuation coefficient at tissue attenuation imaging, Scatter-distribution coefficient at tissue scatter-distribution imaging, Diagnosis