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Background Computed tomography (CT) frequently identifies morphological features suggestive of chronic liver disease (CLD) during imaging performed for unrelated indications. However, its diagnostic accuracy in such incidental settings remains uncertain. This study aimed to assess the concordance and diagnostic accuracy of CT-detected CLD using FibroScan as the reference standard, and to evaluate the performance of noninvasive fibrosis scores.Methods In this prospective observational study, 70 patients with incidentally detected CLD on CT scan were enrolled. CT findings suggestive of CLD included liver surface nodularity, caudate lobe hypertrophy, segmental atrophy/hypertrophy, and portal hypertension features. All patients underwent transient elastography (FibroScan), and liver stiffness measurements were categorized as significant fibrosis (≥F2, ≥8 kPa) and cirrhosis (F4, >14 kPa). Concordance between CT and FibroScan was assessed using Cohen’s kappa. Diagnostic performance of FIB-4 and APRI scores was evaluated using AUROC analysis.Results Among 70 CT-positive patients (mean age 58 years), FibroScan confirmed significant fibrosis (≥F2) in 64.3% and cirrhosis (F4) in 45.7% of cases ( IDDF2026-ABS-0366 Figure 1. What FibroScan actually shows). CT demonstrated substantial overestimation of CLD, with approximately one-third of patients lacking significant fibrosis (IDDF2026-ABS-0366 Figure 2. CT overcalls).Agreement between CT and FibroScan was poor (Cohen’s κ = 0.0), reflecting a lack of concordance beyond chance.Noninvasive scores showed limited diagnostic performance (IDDF2026-ABS-0366 Figure 3. Noninvasive scores are ineffective, IDDF2026-ABS-0366 Figure 4. Poor sensitivity):FIB-4 AUROC: 0.49 (≥F2), 0.57 (F4)APRI AUROC: 0.51 (≥F2), 0.59 (F4)At standard cutoffs, both scores demonstrated low sensitivity and suboptimal specificity, limiting their clinical utility in this cohort.Conclusions CT scan frequently overcalls chronic liver disease in incidentally detected cases and demonstrates poor concordance with FibroScan for fibrosis staging. Noninvasive biochemical scores have limited diagnostic utility in this setting. FibroScan remains essential for accurate confirmation and staging of CLD following incidental CT findings.Abstract IDDF2026-ABS-0366 Figure 1Abstract IDDF2026-ABS-0366 Figure 2Abstract IDDF2026-ABS-0366 Figure 3Abstract IDDF2026-ABS-0366 Figure 4