Utilizing Ultrasound for Estimating Liver Size in Patients with Fatty Liver Disease: A Study in Jeddah, Saudi Arabia

ORIGINAL ARTICLE
Salem Alghamdi, Abdulrahman Tajaldeen, Rowa Aljondi, Abdulrzzag Alghamdi, Hamza Showlag, Abdulaziz Helabi, Samer Ahmed, Saeed Al-Malki, Talal Al-Omari

 
For citation: Alghamdi S, Tajaldeen A, Aljondi R, Alghamdi A, Showlag H, Helabi A, Ahmed S, Al-Malki S, Al-Omari T. Utilizing Ultrasound for Estimating Liver Size in Patients with Fatty Liver Disease: A Study in Jeddah, Saudi Arabia. International Journal of Biomedicine. 2026;16(1):64-70. doi:10.21103/Article16(1)_OA8
 
Originally published March 5, 2026

Abstract: 

Background: Ultrasound is widely used to evaluate liver morphology in nonalcoholic fatty liver disease (NAFLD), yet the relationships between ultrasound-derived liver size and patient characteristics remain incompletely described in Saudi populations. This study assessed the association between right-lobe liver size and demographic/anthropometric variables among adults with ultrasound-confirmed NAFLD in Jeddah, Saudi Arabia.
Methods and Results: This retrospective, cross-sectional, two-center study included 212 adults (≥18 years) with NAFLD documented on ultrasound reports from 2 tertiary hospitals in Jeddah between 2020 and 2025. The primary outcome was right-lobe liver size (cm) extracted from ultrasound reports and/or PACS measurements. Predictors included sex, age, BMI, and hospital site.
Of 212 participants, 114 (53.8%) were female; mean age was 49.5 years, and mean BMI was 31.6 kg/m², with most participants classified as overweight or obese. Mean right-lobe liver size was similar between Hospital A and Hospital B (15.98±2.02 vs 16.07±2.03 cm; P=0.763). Females had numerically larger right-lobe measurements than males in both hospitals, but differences were not statistically significant overall (16.18±2.07 vs 15.84±1.94 cm; P=0.218). Liver size correlated inversely and weakly with age (r=−0.160, P=0.019) and weakly and positively with weight (r=0.221, P=0.001) and BMI (r=0.180, P=0.009). In multivariable regression adjusting for sex, BMI, and hospital, age remained independently associated with liver size (β=−0.023 cm/year; P=0.026), while BMI did not retain significance (β=0.043 cm per kg/m²; P=0.110); sex and hospital were not significant predictors.
Conclusion: In adults with ultrasound-reported NAFLD in Jeddah, right-lobe liver size showed modest associations with age and adiposity, with age remaining an independent predictor after adjustment. Sex-based differences were small and non-significant, and measurements were consistent across two hospitals. Standardized acquisition and inclusion of objective NAFLD severity measures (e.g., elastography and laboratory markers) are needed to refine the interpretation of routine ultrasound liver size metrics in regional NAFLD populations.

Keywords: 
nonalcoholic fatty liver disease • ultrasound • liver size • right lobe • body mass index • B-mode
References: 
  1. Demirturk Kocasarac H, Angelopoulos C. Ultrasound in Dentistry: Toward a Future of Radiation-Free Imaging. Dent Clin North Am. 2018 Jul;62(3):481-489. doi: 10.1016/j.cden.2018.03.007. PMID: 29903563.
  2. Ribeiro R, Sanches J. Fatty liver characterization and classification by ultrasound. Lecture Notes in Computer Science. 2009: 354–361).
  3. Azhari H. Ultrasound: medical imaging and beyond (an invited review). Curr Pharm Biotechnol. 2012 Sep;13(11):2104-16. doi: 10.2174/138920112802502033. PMID: 22335480.
  4. Wells PN. Physics and engineering: milestones in medicine. Med Eng Phys. 2001 Apr;23(3):147-53. doi: 10.1016/s1350-4533(01)00042-x. PMID: 11410379.
  5. Said H.  Principles of ultrasonography.  J Natl Med Assoc. 1974 May;66(3):205-7, 231. 
  6. Rumack CM, Levine D. Published by Elsevier Enhanced Digital Version Copyright© 2024. Print ISBN: 9780323877954
  7. Singh T, Singla B. Clinical and sonographic estimation of liver span in normal healthy adults. International Journal of Medical Research & Health Sciences. 2017; 6(1): 94-97.
  8. Chaurasia BD. Human anatomy: regional and applied upper limb and thorax. CBS Publishers & Distributors. 1984.
  9. Rosenfield AT, Laufer I, Schneider PB. The significance of a palpable liver. A correlation of clinical and radioisotope studies. Am J Roentgenol Radium Ther Nucl Med. 1974 Oct;122(2):313-7. doi: 10.2214/ajr.122.2.313. PMID: 4371591.
  10. Dorostghol M, Gharibvand MM, Hanafi MG, Motamedfar A. Comparison of size of the liver between patients with non-alcoholic fatty liver disease and healthy controls. J Family Med Prim Care. 2024 Feb;13(2):425-430. doi: 10.4103/jfmpc.jfmpc_94_23. Epub 2024 Mar 6. PMID: 38605772; PMCID: PMC11006049.
  11. Petzold G. Role of Ultrasound Methods for the Assessment of NAFLD. J Clin Med. 2022 Aug 5;11(15):4581. doi: 10.3390/jcm11154581. PMID: 35956196; PMCID: PMC9369745.
  12. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-402. doi: 10.1016/j.jhep.2015.11.004. Epub 2016 Apr 7. PMID: 27062661.
  13. Simon TG, Roelstraete B, Khalili H, Hagström H, Ludvigsson JF. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021 Jul;70(7):1375-1382. doi: 10.1136/gutjnl-2020-322786. Epub 2020 Oct 9. PMID: 33037056; PMCID: PMC8185553.
  14. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, Brunt EM, Sanyal AJ. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018 Jan;67(1):328-357. doi: 10.1002/hep.29367. Epub 2017 Sep 29. PMID: 28714183.
  15. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-84. doi: 10.1002/hep.28431. Epub 2016 Feb 22. PMID: 26707365.
  16. Alswat K, Aljumah AA, Sanai FM, Abaalkhail F, Alghamdi M, Al Hamoudi WK, Al Khathlan A, Al Quraishi H, Al Rifai A, Al Zaabi M, Babatin MA, Estes C, Hashim A, Razavi H. Nonalcoholic fatty liver disease burden - Saudi Arabia and United Arab Emirates, 2017-2030. Saudi J Gastroenterol. 2018 Jul-Aug;24(4):211-219. doi: 10.4103/sjg.SJG_122_18. Erratum in: Saudi J Gastroenterol. 2018 Jul-Aug;24(4):255. doi: 10.4103/1319-3767.237645. PMID: 29956688; PMCID: PMC6080149.
  17. Alsabaani AA, Mahfouz AA, Awadalla NJ, Musa MJ, Al Humayed SM. Non-Alcoholic Fatty Liver Disease among Type-2 Diabetes Mellitus Patients in Abha City, South Western Saudi Arabia. Int J Environ Res Public Health. 2018 Nov 11;15(11):2521. doi: 10.3390/ijerph15112521. PMID: 30423871; PMCID: PMC6266142.
  18. Younossi ZM. Review article: current management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2008 Jul;28(1):2-12. doi: 10.1111/j.1365-2036.2008.03710.x. Epub 2008 Apr 11. PMID: 18410557.
  19. Tamaki N, Ajmera V, Loomba R. Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD. Nat Rev Endocrinol. 2022 Jan;18(1):55-66. doi: 10.1038/s41574-021-00584-0. Epub 2021 Nov 23. PMID: 34815553; PMCID: PMC9012520.
  20. van Werven JR, Marsman HA, Nederveen AJ, Smits NJ, ten Kate FJ, van Gulik TM, Stoker J. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010 Jul;256(1):159-68. doi: 10.1148/radiol.10091790. PMID: 20574093.
  21. Petzold G, Lasser J, Rühl J, Bremer SCB, Knoop RF, Ellenrieder V, Kunsch S, Neesse A. Diagnostic accuracy of B-Mode ultrasound and Hepatorenal Index for graduation of hepatic steatosis in patients with chronic liver disease. PLoS One. 2020 May 1;15(5):e0231044. doi: 10.1371/journal.pone.0231044. PMID: 32357147; PMCID: PMC7194436.
  22. de Moura Almeida A, Cotrim HP, Barbosa DB, de Athayde LG, Santos AS, Bitencourt AG, de Freitas LA, Rios A, Alves E. Fatty liver disease in severe obese patients: diagnostic value of abdominal ultrasound. World J Gastroenterol. 2008 Mar 7;14(9):1415-8. doi: 10.3748/wjg.14.1415. PMID: 18322958; PMCID: PMC2693692.
  23. Lee SS, Park SH, Kim HJ, Kim SY, Kim MY, Kim DY, Suh DJ, Kim KM, Bae MH, Lee JY, Lee SG, Yu ES. Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol. 2010 Apr;52(4):579-85. doi: 10.1016/j.jhep.2010.01.008. Epub 2010 Feb 2. PMID: 20185194.
  24. Palmentieri B, de Sio I, La Mura V, Masarone M, Vecchione R, Bruno S, Torella R, Persico M. The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis. Dig Liver Dis. 2006 Jul;38(7):485-9. doi: 10.1016/j.dld.2006.03.021. Epub 2006 May 22. PMID: 16716779.
  25. Dogra VS, Rubens DJ. Ultrasound secrets. Elsevier Health Sciences, 2004.
  26. Ferraioli G, Soares Monteiro LB. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol. 2019 Oct 28;25(40):6053-6062. doi: 10.3748/wjg.v25.i40.6053. PMID: 31686762; PMCID: PMC6824276.
  27. Kim SH, Lee JM, Kim JH, Kim KG, Han JK, Lee KH, Park SH, Yi NJ, Suh KS, An SK, Kim YJ, Son KR, Lee HS, Choi BI. Appropriateness of a donor liver with respect to macrosteatosis: application of artificial neural networks to US images--initial experience. Radiology. 2005 Mar;234(3):793-803. doi: 10.1148/radiol.2343040142. Epub 2005 Jan 21. PMID: 15665225.
  28. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, Clark JM. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011 Sep 2;54(3):1082-1090. doi: 10.1002/hep.24452. PMID: 21618575; PMCID: PMC4197002.
  29. Dasarathy S, Dasarathy J, Khiyami A, Joseph R, Lopez R, McCullough AJ. Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study. J Hepatol. 2009 Dec;51(6):1061-7. doi: 10.1016/j.jhep.2009.09.001. Epub 2009 Sep 20. PMID: 19846234; PMCID: PMC6136148.
  30. Patell R, Dosi R, Joshi H, Sheth S, Shah P, Jasdanwala S. Non-Alcoholic Fatty Liver Disease (NAFLD) in Obesity. J Clin Diagn Res. 2014 Jan;8(1):62-6. doi: 10.7860/JCDR/2014/6691.3953. Epub 2013 Jan 12. PMID: 24596725; PMCID: PMC3939589.
  31. Cruz JF, Cruz MA, Machado Neto J, de Santana DS, Oliveira CC, Lima SO. Prevalence and sonographic changes compatible with fatty liver disease in patients referred for abdominal ultrasound examination in Aracaju, SE. Radiol Bras. 2016 Jan-Feb;49(1):1-5. doi: 10.1590/0100-3984.2014.0124. PMID: 26929453; PMCID: PMC4770388.
  32. Kratzer W, Fritz V, Mason RA, Haenle MM, Kaechele V; Roemerstein Study Group. Factors affecting liver size: a sonographic survey of 2080 subjects. J Ultrasound Med. 2003 Nov;22(11):1155-61. doi: 10.7863/jum.2003.22.11.1155. PMID: 14620885.
  33. Ozturk A, Kumar V, Pierce TT, Li Q, Baikpour M, Rosado-Mendez I, Wang M, Guo P, Schoen S Jr, Gu Y, Dayavansha S, Grajo JR, Samir AE. The Future Is Beyond Bright: The Evolving Role of Quantitative US for Fatty Liver Disease. Radiology. 2023 Nov;309(2):e223146. doi: 10.1148/radiol.223146. PMID: 37934095; PMCID: PMC10695672.
  34. Fetzer DT, Pierce TT, Robbin ML, Cloutier G, Mufti A, Hall TJ, Chauhan A, Kubale R, Tang A. US Quantification of Liver Fat: Past, Present, and Future. Radiographics. 2023 Jul;43(7):e220178. doi: 10.1148/rg.220178. PMID: 37289646.
  35. Ballestri S, Romagnoli D, Nascimbeni F, Francica G, Lonardo A. Role of ultrasound in the diagnosis and treatment of nonalcoholic fatty liver disease and its complications. Expert Rev Gastroenterol Hepatol. 2015 May;9(5):603-27. doi: 10.1586/17474124.2015.1007955. Epub 2015 Feb 19. PMID: 25694178.
  36. Mishra P, Younossi ZM. Abdominal ultrasound for diagnosis of nonalcoholic fatty liver disease (NAFLD). Am J Gastroenterol. 2007 Dec;102(12):2716-7. doi: 10.1111/j.1572-0241.2007.01520.x. PMID: 18042105.
  37. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-402. doi: 10.1016/j.jhep.2015.11.004. Epub 2016 Apr 7. PMID: 27062661.
  38. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, Harrison SA, Brunt EM, Sanyal AJ. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018 Jan;67(1):328-357. doi: 10.1002/hep.29367. Epub 2017 Sep 29. PMID: 28714183.

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Received January 1, 2026.
Accepted February 15 26, 2026.
©2026 International Medical Research and Development Corporation.