Which of the following best describes how fatty infiltration appears on ultrasound gray-scale imaging?

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Fatty infiltration increases the liver’s echogenicity on gray-scale ultrasound. When fat accumulates diffusely in hepatocytes, the entire liver becomes brighter than normal because fat reflects ultrasound more than normal liver tissue and attenuates deeper echoes. This produces a uniform, diffuse increased echogenic appearance, often making the liver appear brighter than the spleen or kidneys. While focal fatty change or sparing can occur, the typical pattern researchers look for in hepatic steatosis is diffuse increased echogenicity.