Abstract
Ultrasound is the most widely used imaging modality for liver evaluation because it is accessible, portable, affordable, and repeatable. Quantitative liver ultrasound should therefore be understood not as a single technology, but as a set of biomarker strategies at different stages of development. Ultrasound elastography is the most mature component of this field and has been incorporated into noninvasive pathways for fibrosis assessment. Ultrasound-based liver fat quantification is also advancing rapidly through attenuation, backscatter, and radiofrequency-based techniques. A newer area of investigation involves the evaluation of viscoelasticity and inflammatory activity using shear-wave dispersion and related biomarkers, particularly in metabolic dysfunction-associated steatotic liver disease. The future value of quantitative liver ultrasound will depend on integrating multiple parameters to support clinical triage, monitoring, and, increasingly, treatment decision-making.