Liver steatosis is a key feature of metabolic dysfunction-associated steatotic liver disease (MASLD) (1), which affects over a quarter of the world’s population and is increasing in prevalence (2). MASLD can progress to significant steatohepatitis, advanced fibrosis, and cirrhosis. The worsening of liver fibrosis is associated with higher risk of liver-related complications, including hepatocellular carcinoma. Additionally, MASLD is linked to a higher prevalence of cardiovascular disease, chronic kidney disease, type 2 diabetes mellitus, and obstructive sleep apnea (1).

Liver biopsy remains the reference standard for quantifying liver fat content. However, due to its invasive nature, it is not routinely used in clinical practice. The Controlled-Attenuation Parameter (CAP) measured using vibration-controlled transient elastography (VCTE, FibroScan®) is  widely used to assess liver steatosis (3). CT is not the first-line modality for evaluating liver fat content, it plays an important role in the incidental detection of hepatic steatosis due to its frequent use for other indications. (4). Establishing the cutoff values and accuracy of CT for predicting steatosis degrees, especially against CAP, could improve its role in MASLD, possibly facilitating earlier intervention and better patient outcomes.

We aimed to assess the diagnostic performance of CAP (VCTE) in quantifying liver steatosis in biopsy-proven chronic liver diseases (CLD) and to perform a head-to-head comparision with unenhanced CT scan methods.