Abstract: Objective To investigate the severity of metabolic-associated fatty liver disease (MAFLD) using multimodal imaging technology (MIT) in conjunction with ultrasonic shear-wave elastography (SWE).Methods From January 2020 to December 2021, 198 patients suspected of having MAFLD were studied. They were categorized based on liver pathology biopsy results into an MAFLD group (observation group, n=174) and a NON-MAFLD group (control group, n=24). The observation group was further classified by disease severity into mild(n=61), moderate(n=87), and severe (n=26) subgroups. Both MIT and SWE were performed on these subgroups. Liver Young′s modulus and proton density fat fraction (PDFF) were observed across all groups. Pearson analysis was conducted to determine the correlation between zthe liver Young′s modulus, PDFF and the triacylglycerol glucose index (TyG) . Additionally, the receiver operating characteristic curve (ROC) was utilized to assess the efficacy of both MIT and SWE, individually and combined, in evaluating MAFLD. Results In the observation group, the liver Young′s modulus was 5.78± 0.56 kpa and the PDFF was 20.33±2.10%. Both values were siginidicantly higher than in the control group, where they were 3.27± 0.33 kpa and 6.53±0.61%, respectively (t=8.510 and 13.429, both P<0.05). Within the severe subgroup, the liver Young′s modulus and PDFF were 6.34±0.64 kPa and 25.97±2.13%, respectively, surpassing the figures of the moderate and mild subgroups (5.59±0.51 kPa, 19.56±1.76% and 4.98±0.42 kPa, 12.37±1.08%, respectively). These differences also held statistically significant (F=13.395, 19.786, all P<0.05). A postive correlation was found between the Liver Young′s modulus, PDFF and TyG in patients with MAFLD (P<0.01). ROC analyses revealed AUC values of 0.801, 0.859 and 0.925 for MIT. SWE, and their combined tests, respectively. The combined tests` sensitivity and specificity exceeded those of the SWE alone (P<0.01). Conclusion Multimodal imaging in conjunction with ultrasound shear-wave elastography demonstrateds significant diagnostic value in the assessment of MAFLD.

Key words: MAFLD, MIT, SWE, Pregnancy outcomes