Background: Early diagnosis of liver fibrosis is crucial for clinical intervention and prognosis assessment. Due to its non-invasiveness, convenience, and low cost, ultrasound has become a common screening tool for liver fibrosis. However, its diagnostic performance is influenced by various factors, including the degree of fibrosis, operator experience, and etiology. Objective: This study aimed to evaluate the diagnostic value of ultrasound for liver fibrosis at different stages and explore the impact of physician experience, liver disease types, and other imaging modalities on diagnostic outcomes. Methods: This single-center retrospective study included 890 patients who underwent both liver histopathology and ultrasound examinations at Peking University Shenzhen Hospital from 2014 to 2024. By comparing ultrasound reports with pathological results, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated. The study focused on: (1) the diagnostic performance of ultrasound for early fibrosis (Scheuer score >S0, 10 years); (3) the influence of different liver disease types; and (4) a comparison of diagnostic efficacy among ultrasound, CT with MRI. Results: Ultrasound demonstrated good diagnostic performance for cirrhosis, with a sensitivity of 34.66%, specificity of 89.89%, and accuracy of 72.70%. However, its sensitivity for early fibrosis was only 6.16%, though specificity remained high (94.15%). For advanced fibrosis, sensitivity was 29.44%, with slightly reduced specificity (84.01%). Diagnostic performance varied by physician experience: those with 5-10 years of experience achieved the highest specificity (98.70%) for early fibrosis, while those with >10 years had higher sensitivity (33.33%) for advanced fibrosis. Ultrasound exhibited the highest sensitivity (59.06%) but lower specificity (73.15%) for viral hepatitis-related advanced fibrosis and cirrhosis, while non-alcoholic fatty liver disease had the highest specificity (97.67%) but low sensitivity (30.00%). Ultrasound outperformed CT and MRI in sensitivity for early and advanced fibrosis but had lower specificity. For cirrhosis, CT and MRI showed slightly better sensitivity than ultrasound, though with lower specificity. Conclusion: The diagnostic performance of imaging techniques varies depending on the stage and etiology of liver fibrosis, and physician experience also influences outcomes. Ultrasound demonstrates superior sensitivity compared to CT and MRI, and its balanced diagnostic performance, low cost, and repeatability make it an indispensable first-line tool for liver fibrosis screening and long-term monitoring. However, its sensitivity remains suboptimal, particularly for early fibrosis. Optimizing ultrasound technology to improve early detection is essential for enhancing clinical outcomes.

Liver Fibrosis, Cirrhosis, Diagnosis, Ultrasound, Diagnosis, Computer Tomography, Magneticresonance Imaging