Which imaging feature is used to detect fatty infiltration and tumors on liver ultrasound?

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Gray-scale (B-mode) ultrasound is focused on the structural appearance of the liver. Fatty infiltration changes the liver parenchyma to become more echogenic, making it look brighter than normal and often reducing depth penetration, which helps reveal diffuse steatosis. For tumors, gray-scale imaging shows focal abnormalities as lesions that are hypo- or hyperechoic against the surrounding liver, with irregular or well-defined margins and internal texture that stand out on the parenchymal background. These structural changes are the primary way fatty changes and focal lesions are detected at ultrasound.

Color Doppler, elastography, and spectral Doppler provide additional information about blood flow and tissue stiffness, but they are not the main features used to detect fatty infiltration or discover liver tumors.