Hepatic steatosis is very common and has a broad disease spectrum according to etiology and severity (1). Clinically, the occurrence of non-alcoholic fatty liver disease (NAFLD), the most common type of hepatic steatosis, is strongly correlated with metabolic disease, including type 2 diabetes mellitus and atherosclerotic cardiovascular disease (2). Simple hepatic steatosis can evolve into a more severe stage such as steatohepatitis or cirrhosis. Furthermore, hepatic steatosis is an important risk factor for postoperative complications after major liver resection and living donor liver transplantation (3-7). Hepatic steatosis of ≥ 10% is known to be critical in patients undergoing living donor liver transplantation due to the risks of initial graft dysfunction, poor graft survival and other complications (8-10). The widespread use of liver biopsy, a reference standard for quantification of liver fat, as a screening tool and for monitoring treatment response is limited mainly because of invasiveness. Therefore, noninvasive imaging methods that can quantitatively measure liver fat have been actively investigated. Among them, 1H-magnetic resonance spectroscopy (1H-MRS) has gained ground in the past decade as an alternative noninvasive reference standard for evaluating liver fat content because of its high diagnostic accuracy and reproducibility (1, 2, 11-15). However, MRS is expensive to perform as a screening and monitoring tool for hepatic steatosis. Ultrasound (US) is an imaging modality that is simple and inexpensive to perform and is safe for the patient. To overcome the intrinsic subjectivity associated with the use of US in grading fatty liver, several methods using US image data have been proposed for the quantification of hepatic steatosis (14-20). However, these methods are not widely used in clinical practice, mainly because of their complexity or their use of non-commercial software. Recently, ultrasound-based liver fat quantification tools such as controlled attenuation parameter (CAP) or Acoustic structure quantification (ASQ) have been introduced into clinical practice. CAP measures the degree of ultrasound attenuation due to hepatic fat, which is implemented on Fibroscan. CAP values have been reported to have an excellent diagnostic accuracy for steatosis detection, which an adjusted AUROC of 0.914. However, technical failure rate was reported to be 7.7 % of cases (21). ASQ method is based on statistical analysis of the difference between theoretical and real echo amplitude distribution (22, 23). In a population of living donors for liver transplantation, ASQ provides an excellent quantitative tool for hepatic steatosis, and there is a strong linear correlation (r= - 0.87, P< 0.0001) between focal disturbance ratio measured using ASQ and hepatic fat fraction measured using MR spectroscopy (24).