There are no other imaging findings associated with non-alcoholic fatty liver disease.

Vibration-controlled transient elastography is used to noninvasively measure liver stiffness and is commonly used after FIB-4 testing in patients at increased risk for advanced fibrosis. A liver stiffness measurement greater than 8.0 kPa should prompt referral to a hepatologist for further evaluation.

Two-dimensional shear wave elastography [SWE]) can estimate liver stiffness measurements: “LS of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. LS highly correlates with portal pressure, and esophageal varices are likely at values >20 kPa.”^[1]

• LS of 8 suggests F3 fibrosis
• LS of 12.5 kPa suggests F4 fibrosis

A more recent study suggests lower cutoffs^[2]:

• LS of 6 suggests F2 fibrosis
• LS of 7 suggests F3 fibrosis
• LS of 11 kPa suggests F4 fibrosis

The FibroScan can measure LSM by SWE

Magnetic resonance elastography (MRE) may be more accurate than elastography^[3]

Hepattic steatosis can be measured with the Controlled attenuation parameter (CAP).^[4][2][5]

The controlled attenuation parameter measures attenuation of ultrasound waves through the liver and is usually performed with vibration-controlled transient elastography. A controlled attenuation parameter value of 248 dB/m or greater is considered diagnostic for hepatic steatosis, and higher values indicate more severe steatosis.

Compared with conventional ultrasonography, controlled attenuation parameter has similar sensitivity and slightly higher specificity, approximately 90%, for detecting hepatic steatosis.

CT scan: “≤ 40 Hounsfield units indicating > 30% hepatic steatosis”^[6].