Abstract: Objective The aim of this study was to compare diagnostic efficacy of transient elastography (TE) to two-dimensional shear wave elastography (2D-SWE) in assessing significant liver fibrosis (SLF) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods A total of 110 patients with MAFLD were encountered in our hospital between March 2022 and October 2024, and all underwent liver biopsies. TE was performed to obtain liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and Young's modulus was obtained by 2D-SWE. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance. Results Of the 110 patients with MAFLD, liver histo-pathological examination proven metabolic related simple fatty liver (MRSFL) in 62 cases and metabolic dysfunction-associated steatohepatitis(MASH) in 48 cases, including F2 stage of liver fibrosis in 30 cases, F3 in 15 cases and F4 in 3 cases; serum total cholesterol, triglyceride, low-density lipoprotein and alanine aminotransferase levels in patients with MASH were significantly higher, while serum high-density lipoprotein level was significantly lower than in patients with MRSFL(P<0.05); CAP, LSM and Young's modulus in patients with MASH were (315.2±20.6)dB/m, (12.0±2.3)kPa and (10.1±2.1)kPa, all much higher than [(267.8±8.4)dB/m,(5.9±1.4)kPa and (4.9±1.4)kPa, respectively, P<0.05] in those with MRSFL; ROC analysis showed that the AUC was 0.899(95%CI: 0.831-0.987), with sensitivity (Se) of 0.888 and specificity (Sp) of 0.826, when LSM was applied to predict SLF, and the AUC was 0.885 (95%CI:0.822-0.949), with Se of 0.796 and Sp of 0.806, when Young's modulus was applied. Conclusion Both LSM and 2D-SWE could help predict SLF non-invasively in patients with MAFLD, which should be a widespread tool for clinical application.

Key words: Metabolic dysfunction-associated fatty liver disease, Liver fibrosis, Transient elastography, Shear wave elastography, Diagnosis