What does no significant hepatic (liver) steatosis mean?

What "No Significant Hepatic Steatosis" Means

"No significant hepatic steatosis" means the liver contains less than 5% fat content by weight, which is considered the threshold for diagnosing fatty liver disease and represents a normal or near-normal liver. 1

Clinical Definition and Thresholds

The term "significant" in hepatic steatosis has specific quantitative meaning:

• Hepatic steatosis is defined as intrahepatic fat comprising at least 5% of liver weight 1, 2
• Below this 5% threshold, the liver is considered to have no clinically significant fat accumulation 1
• This 5% cutoff is used universally to distinguish normal liver from nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) 1

Grading Context

When steatosis is present, it is classified by severity, which helps contextualize what "no significant" means:

• Mild steatosis: 5-33% of hepatocytes containing fat 1
• Moderate steatosis: 33-60% of hepatocytes containing fat 1
• Severe steatosis: >60% of hepatocytes containing fat 1

Therefore, "no significant hepatic steatosis" indicates fat content below the mild category threshold 1

Clinical Implications

A finding of no significant hepatic steatosis is reassuring and indicates:

• The liver has normal or near-normal fat content and does not meet criteria for NAFLD/MASLD 1
• There is no hepatic manifestation of metabolic syndrome from this perspective 3
• The patient does not have the hepatic component that could progress to steatohepatitis (NASH), fibrosis, or cirrhosis 1
• No increased risk of liver-related morbidity or mortality from fatty liver disease 3

Diagnostic Considerations

The determination of "no significant steatosis" depends on the imaging modality used:

• Ultrasound can detect moderate to severe steatosis with 84.8% sensitivity and 93.6% specificity, but may miss mild steatosis 4
• MRI is the gold standard for quantifying liver fat and can accurately detect fat fractions below 5% 1
• Liver biopsy remains the definitive method but is rarely needed when imaging shows no steatosis 1

A common pitfall: ultrasound may report "no significant steatosis" but could miss early fat accumulation below detection thresholds, particularly in patients with metabolic risk factors 1, 4

What This Does NOT Rule Out

Important caveats when interpreting "no significant hepatic steatosis":

• This finding does not exclude other liver diseases (viral hepatitis, autoimmune hepatitis, Wilson's disease, etc.) 1
• It does not rule out metabolic syndrome or cardiovascular risk from other sources 5
• Patients can still have elevated liver enzymes from non-steatotic causes 5
• In patients with strong metabolic risk factors (obesity, type 2 diabetes), serial monitoring may still be warranted as steatosis can develop over time 1, 4