Liver Steatosis—Diagnosis and Controverses Involving Conventional Ultrasound Examination and Transient Elastography Assessment a Retrospective Cross-Sectional Study

During routine evaluation of hospitalized patients, discrepancies were frequently observed between the degree of liver steatosis assessed by conventional B-mode ultrasonography and Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP). This study aimed to identify the factors contributing to these differences and to determine whether both imaging methods should be expected to produce comparable steatosis classifications. We conducted an observational retrospective cross-sectional study including 130 patients admitted over a two-year period who underwent laboratory testing, abdominal ultrasonography, and transient elastography. Variables analyzed included age, sex, environment, nutritional status, comorbidities, biochemical parameters (ALAT, total cholesterol, triglycerides, GGT), calculated FIB-4 score. Patients were classified in two groups: 61 with concordant steatosis grades across both methods and 69 with discordant results. Concordant results were more common in individuals with serum total cholesterol >200 mg/dL (45.9%), and those with a Fib-4 score between 1.45–3.25 (44.2%). Additionally, a trend toward a stronger correlation was observed in patients with elevated triglycerides. Viral liver disease showed a significantly higher rate of discordant results (26.2%). Total serum cholesterol >200 mg/dL, and a FIB-4 score between 1.45–3.25 can be significantly associated with concordance in steatosis grading, while serum triglyceride levels showed a nonsignificant trend toward concordance. In contrast, viral hepatitis with concomitant steatosis can be associated with discordant findings between the two imaging modalities. Although not statistically significant, a value F ≥ 2 measured by VCTE measured fibrosis and a FIB-4 score >3.25 also showed a trend toward discordance, suggesting they may contribute to variability in steatosis assessment.