Ahmed Ezzat HELAL, Mohamed ELBASIONY, Ahmed ABDEL-RAZIK, Nasser MOUSA, Gamal SHIHA
Hepatology Forum - 2026;7(3):269-276
Background and Aim: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a global health concern. Endoscopic ultrasound (EUS) combines multiple diagnostic modalities, including elastography. This study aimed to evaluate the diagnostic performance of EUS strain elastography parameters in patients with MASLD, compared with vibration-controlled transient elastography (VCTE) and non-invasive markers. Materials and Methods: A total of 75 adults with MASLD underwent EUS strain elastography. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were measured by VCTE. Assessments of non-invasive biomarkers, including the fibrosis index based on six parameters (FIB-6) and fatty liver index (FLI), were conducted. Results: The liver strain histogram (SH) standard deviation (SD) could diagnose steatosis when referenced by CAP, with an area under the receiver operating characteristic curve (AUROC) of 0.707 (p=0.029). Both liver SH SD (AUROC=0.883, p<0.001) and liver SH mode percentage (Mode%) (AUROC=0.836, p<0.001) could diagnose steatosis when referenced by FLI (FLI >=30). The liver strain ratio (SR) could diagnose advanced fibrosis (rule-in stage >=F3) when referenced by LSM, yielding an AUROC of 0.677 and p=0.048. Liver SR (AUROC=0.707, p=0.002) and liver SH Mode% (AUROC=0.725, p<0.001) could diagnose significant fibrosis (stage >=F2) when referenced by FIB-6 (FIB-6 >=2.003). Conclusion: SH SD shows potential for detecting steatosis, and SR with SH Mode% could be indicative of fibrosis (significant and advanced). However, further biopsy-based studies are needed.
