{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:04:18Z","timestamp":1789553058559,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: To derive computed tomography (CT) attenuation thresholds for grading hepatic steatosis and evaluate their agreement with ultrasonography (US) in adults with overweight or obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) from southeastern Mexico. Methods: Adults (\u226518 years) with MASLD who underwent both CT and US were included. Hepatic steatosis on CT was defined by liver attenuation &lt; 40 Hounsfield units (HU) or a liver-to-spleen attenuation difference &gt; 10 HU. US steatosis was graded using a three-point echogenicity scale. CT attenuation thresholds were derived in a training dataset (70%) using sequential receiver operating characteristic (ROC) analyses and the Youden index and were subsequently evaluated in an internal hold-out dataset (30%). Histopathological findings were available in a subgroup for additional evaluation. Agreement between CT-predicted and US-based steatosis grades was assessed using Spearman\u2019s rank correlation coefficient (\u03c1) and quadratic-weighted Cohen\u2019s kappa (\u03ba). Results: In total, 105 participants were included. The training-set ROC analyses identified CT attenuation thresholds of \u226428.15 HU for Grade 3 steatosis (AUC = 0.995), 28.15\u201335.50 HU for Grade 2 (AUC = 0.983), and &gt;35.50 HU for Grade 1. In the internal hold-out dataset, CT-predicted and US-based steatosis grades showed a strong positive correlation (\u03c1 = 0.946, p &lt; 0.001) and almost perfect agreement (quadratic-weighted \u03ba = 0.940, p &lt; 0.001). Liver biopsy data were available for 16 participants, and CT-predicted steatosis grade was positively associated with histological fat percentage (\u03c1 = 0.595, p = 0.015). Conclusions: The proposed CT attenuation thresholds showed high agreement with US-based steatosis grading, and their association with histopathological fat content provided additional supportive evidence in a subgroup of participants. These findings suggest that CT attenuation may provide a useful quantitative approach to grading hepatic steatosis and could contribute to more consistent steatosis assessment across different healthcare settings.<\/jats:p>","DOI":"10.3390\/diagnostics16182996","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:06:37Z","timestamp":1789549597000},"page":"2996","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CT Attenuation Thresholds for Grading Hepatic Steatosis in Adults with Overweight or Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease"],"prefix":"10.3390","volume":"16","author":[{"given":"Paul","family":"G\u00f3ngora-Chan","sequence":"first","affiliation":[{"name":"Departamento de Imagenolog\u00eda Diagn\u00f3stica y Terap\u00e9utica, Hospital Regional de Alta Especialidad de la Pen\u00ednsula de Yucat\u00e1n, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-Bienestar), M\u00e9rida 97130, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Ricardo Emmanuel","family":"Jimeno-Figueroa","sequence":"additional","affiliation":[{"name":"Departamento de Imagenolog\u00eda Diagn\u00f3stica y Terap\u00e9utica, Hospital Regional de Alta Especialidad de la Pen\u00ednsula de Yucat\u00e1n, Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar (IMSS-Bienestar), M\u00e9rida 97130, 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