Table 4.

Comparison of ultrasound, CT and MRI-PDFF for clinical care and clinical trials in hepatic steatosis

	Advantages	Disadvantages	Recommendations
Ultrasound	Safe Widely available Low cost	Indirect measurement Qualitative Operator and calibration dependent Inaccurate for mild steatosis Inaccurate steatosis grading Confounders: obesity, fibrosis Imprecise localization	Clinical care: initial screen Clinical trials: do not recommend
CT	Fast acquisition Easy to perform Straightforward analysis Quantitative	Indirect measurement Variable calibration Inaccurate for mild steatosis Confounders: iron, glycogen Ionising radiation Requires standard acquisition if contrast-enhanced	Clinical care: retrospective with conservative thresholds Clinical trials: do not recommend
MRI-PDFF	Direct measurement Precise fat quantification Highly sensitive and specific Corrects for confounders Fast acquisition	Relatively limited access Claustrophobia Implantable devices	Clinical care: study of choice (if available) Clinical trials: study of choice (if available)

PDFF, proton-density fat fraction.