Abstract: Objective The aim of this study was to investigate diagnostic efficacy of FibroScan and liver-spleen CT (CT_L/S) ratio combination in predicting hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods 106 patients with NAFLD were enrolled in our hospital between January 2023 and June 2025, and they all received liver biopsy for pathological examination, FibroScan for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), and CT scan for CT_L/S ratio. Multivariate linear regression analysis was applied to evaluate the correlation between FibroScan parameters, CT_L/S ratio and hepatic steatosis in patients with NAFLD. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of FibroScan parameters and CT_L/S ratio in predicting severe hepatic steatosis. Results Liver histo-pathological examination found mild hepatic steatosis in 32 cases, moderate in 39 cases and severe in 35 cases; body mass index, waist-to-hip ratio, LSM and CAP in patients with severe liver steatosis were (29.3±2.1)kg/m², (1.3±0.4), (10.1±1.4)kPa and (327.6±32.0)dB/m, all significantly higher than [(26.0±2.2)kg/m², (1.1±0.2), (8.4±1.2)kPa and (288.7±27.6)dB/m, respectively, P<0.05] in those with moderate liver steatosis or [(24.7±2.1)kg/m², (0.9±0.1), (7.5±1.3)kPa and (265.8±25.9)dB/m, respectively, P<0.05] in those with mild liver steatosis, while CT_L/S ratio was (0.5±0.1), significantly lower than [(0.6±0.1), P<0.05] in those with moderate or [(0.7±0.1), P<0.05] in those with mild liver steatosis; multivariate linear regression analysis found CAP was positively correlated to(β=0.366, 95%CI 0.148-0.687, P=0.006), while CT_L/S ratio was negatively correlated to liver steatosis(β=-0.235, 95%CI -0.101-0.393, P=0.015); ROC analysis showed that the AUC was 0.880 (95% CI:0.809-0.950), with sensitivity of 80.0% and specificity of 74.6%, when CAP was combined with CT_L/S ratio in predicting severe liver steatosis in patients with NAFLD. Conclusion CT_L/S ratio and CAP combination is helpful in screening liver steatosis in patients with NAFLD, which might guide clinicians take appropriate measures for intervention.

Key words: Nonalcoholic fatty liver disease, Hepatic steatosis, FibroScan, Liver-spleen CT ratio, Controlled attenuation parameter, Diagnosis