ABSTRACT Objective To analyze the relevant influencing factors of the pancreatic-splenic ultrasound gray-scale ratio (UGSR) calculated from ultrasound gray-scale histogram measurements and to assess the clinical value of ultrasound quantitative diagnosis of non-alcoholic fatty pancreas disease (NAFPD). Methods: We selected 95 hospitalized patients who underwent abdominal CT and ultrasound at our hospital. Based on the CT diagnostic criteria, patients were divided into the NAFPD group (44 cases) and the non-NAFPD group (51 cases). Gray-scale histograms were used to measure the average gray-scale values of the pancreatic and splenic regions of interest (ROI), and the ratio of these values was calculated as the pancreatic-splenic UGSR. Clinical data of the patients were collected. Univariate and multivariate linear regression analyses were used to identify the influencing factors of pancreatic-splenic UGSR. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of UGSR for NAFPD. Results: Univariate analysis indicated that age, body mass index (BMI), blood pressure, fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), and low-density lipoprotein (LDL) were significant influencing factors of pancreatic-splenic UGSR (all P<0.05). Multivariate regression analysis showed that BMI and FBG were independent influencing factors of pancreatic-splenic UGSR (all P<0.05). ROC curve analysis revealed that the area under the curve for UGSR in diagnosing NAFPD was 0.929 (95% confidence interval: 0.858–0.972), with a cutoff value of 1.64, corresponding to a sensitivity of 97.73% and a specificity of 88.24%. Conclusion: The pancreatic-splenic UGSR, calculated from ultrasound gray-scale histogram measurements, demonstrates good diagnostic performance for NAFPD, and BMI and FBG are independent influencing factors of pancreatic-splenic UGSR.