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ForumsMASH / Liver DiseaseHepatic steatosis grading on ultrasound — my results so far

Hepatic steatosis grading on ultrasound — my results so far

MounjBrad Thu, Mar 5, 2026 at 5:27 PM 8 replies 778 viewsPage 1 of 2
MounjBrad
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Mar 5, 2026 at 5:27 PM#1

Fatty liver on an incidental scan two years ago and nobody followed it up. Now that I am losing weight I would like to know what to re-measure.

What I am trying to establish is whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is.

Tell me what I have not thought of.

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Dr.NateNeph
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Mar 5, 2026 at 6:00 PM#2
MounjBrad said:
Fatty liver on an incidental scan two years ago and nobody followed it up.

ATTAIN trial (survodutide) context for liver and MASH: survodutide, a GLP-1/glucagon dual agonist, showed -18.7% body weight at 46 weeks in the Phase 3 ATTAIN trial. NASH resolution was achieved in ~60% of patients[1].

This is relevant to liver and MASH because survodutide's glucagon agonism specifically targets hepatic lipid metabolism — making it potentially the best-in-class agent for NASH/MAFLD comorbid with obesity.

References:
[1] Sanyal AJ, et al. N Engl J Med. 2024.
Last edited: Mar 5, 2026 at 8:00 PM
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JakeSmashed95
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Mar 5, 2026 at 6:33 PM#3
Dr.NateNeph said:
ATTAIN trial (survodutide) context for liver and MASH: survodutide, a GLP-1/glucagon dual agonist, showed -18.7% body weight at 46 weeks in the Phase…

Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD). After 7 months on GLP-1 therapy:

MarkerBaselineCurrentNormal Range
ALT55277-56 U/L
AST532110-40 U/L
GGT90299-48 U/L
ALP1008244-147 U/L

FibroScan also improved — liver stiffness from 9.5 kPa to 6.2 kPa. The evidence for GLP-1 agonists in NAFLD/NASH is very promising.

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dan_philly
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Mar 5, 2026 at 7:06 PM#4
MounjBrad said:
Fatty liver on an incidental scan two years ago and nobody followed it up.

Adding a me-too, because a thread of one person's experience is not much use. I had assumed I was the exception until I read this.

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MASHdoc_SA
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San Antonio, TX
Mar 5, 2026 at 10:11 PM#5

Adding the clinical framing, because it changes how the question reads.

Liver ultrasound comparison for liver and MASH: my hepatologist ordered serial ultrasounds to track NAFLD regression.

Baseline: "Moderate hepatic steatosis, liver span 17.2cm, echogenic texture consistent with fat infiltration"
Month 8: "Mild steatosis, liver span 15.8cm, improved echogenicity"
Month 14: "Minimal to no steatosis, normal liver span 14.5cm, normal echotexture"

My liver literally shrank and de-fattened. The ultrasound tech said she's seen this pattern increasingly in GLP-1 patients and it's remarkable how consistently the fatty liver resolves.

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