Correlation between Ultrasonography and Mri in Evaluating Fatty Liver

Abstract

Introduction:

Non-alcoholic fatty liver disease (NAFLD) is a growing global health concern associated with obesity and metabolic syndrome. While magnetic resonance imaging–proton density fat fraction (MRI-PDFF) is considered the gold standard for hepatic fat quantification, ultrasonography (USG) remains a widely used screening tool due to its accessibility and cost-effectiveness. This study is aimed to evaluate the role USG and MRI in assessing fatty liver severity and to  correlate between their diagnostic accuracy.

METHODS:

A retrospective observational study was conducted at Meenakshi Medical College Hospital from January 2024 to March 2025. Fifty patients who underwent USG  for suspected fatty liver were included. MRI upper abdomen screening was performed for all the patients who underwent USG. USG grading was based on liver echogenicity and MRI grading based on MRI-PDFF quantified hepatic fat fraction using the mDIXON-Quant sequence. The agreement and correlation between modalities were assessed using chi-square analysis and Kendall’s Taub.

Results:

USG and MRI demonstrated substantial agreement, especially for grade 0 (80%) and grade I (70.8%) steatosis. A strong positive correlation was observed (Kendall’s Tau-b = 0.776, p < 0.001). MRI-PDFF showed excellent diagnostic performance with 97.5% sensitivity and 100% specificity (AUC = 1.00), while USG demonstrated 92.31% sensitivity and 72.73% specificity (AUC = 0.906). Also  MRI showed superior diagnostic efficacy especially in identifying early or subtle steatotic changes.

Conclusion:

Though USG remains a valuable initial screening tool, MRI is a superior modality for accurately quantifying hepatic steatosis and should be considered the reference standard, particularly for early-stage disease.