In this study, a total of 50 patients were included and subjected to histopathological evaluation. Based on the findings, 10 patients were diagnosed with simple hepatosteatosis, whereas 26 patients were found to have steatohepatitis. Additionally, 10 patients who exhibited normal histological characteristics were assigned to the control group. Among the individuals diagnosed with steatohepatitis, fibrosis was detected in 13 cases, while the remaining 13 patients showed no histopathological evidence of fibrosis.

The assessment of shear wave elastography parameters revealed that median point shear wave elastography (pSWE) and automated point shear wave elastography (auto-pSWE) values were significantly elevated in patients presenting with advanced fibrosis (stage 3–4) compared to those without fibrosis. Specifically, in patients with no histopathological evidence of fibrosis, the median pSWE and auto-pSWE values were measured at 4.1 kPa. In contrast, in individuals diagnosed with stage 3–4 fibrosis, the median pSWE and auto-pSWE values were recorded at 7.7 kPa. However, when evaluating the ultrasound-derived fat fraction (UDFF) values across different fibrosis stages, no statistically significant difference was observed.

A correlation analysis was conducted to examine the relationship between fibrosis staging and shear wave elastography parameters. A statistically significant positive correlation was identified between fibrosis stage and both pSWE (r=0.483; p<0.001) and auto-pSWE (r=0.448; p=0.001). These findings suggest that increased stiffness, as measured by both pSWE and auto-pSWE, is associated with higher stages of fibrosis, reinforcing their potential utility in fibrosis assessment.

For the differentiation of patients with fibrosis (≥F1) from those without fibrosis (F0) in the context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), optimal cutoff values were established for the shear wave elastography parameters. The cutoff value for pSWE was determined to be ≥5.05 kPa, which demonstrated a sensitivity of 84.6% and a specificity of 84.6% (AUC=0.879; p<0.001). Similarly, for auto-pSWE, the optimal cutoff value was identified as ≥4.95 kPa, exhibiting identical sensitivity and specificity values (AUC=0.864; p<0.001). These findings indicate that both pSWE and auto-pSWE can serve as reliable diagnostic tools for the identification of MASLD patients with fibrosis.

Furthermore, within the steatohepatitis subgroup, UDFF values exhibited a moderate negative correlation with pSWE (r=-0.401; p=0.042) and auto-pSWE (r=-0.651; p<0.001), suggesting an inverse relationship between hepatic fat content and liver stiffness. Additionally, a weak positive correlation was observed between the Non-Alcoholic Fatty Liver Disease (NAFLD) activity score (NAS) and auto-pSWE (r=0.375; p=0.024). However, no statistically significant association was identified between NAS and either UDFF or pSWE values (p>0.05).