Non-invasive precise staging of liver fibrosis using deep residual network model based on plain CT images

Advancements of non‐invasive imaging technologies for the diagnosis and staging of liver fibrosis: Present and future

Liver fibrosis is a reparative response triggered by liver injury. Non‐invasive assessment and staging of liver fibrosis in patients with chronic liver disease are of paramount importance, as treatment strategies and prognoses depend significantly on the degree of fibrosis. Although liver fibrosis has traditionally been staged through invasive liver biopsy, this method is prone to sampling errors, particularly when biopsy sizes are inadequate. Consequently, there is an urgent clinical need for an alternative to biopsy, one that ensures precise, sensitive, and non‐invasive diagnosis and staging of liver fibrosis. Non‐invasive imaging assessments have assumed a pivotal role in clinical practice, enjoying growing popularity and acceptance due to their potential for diagnosing, staging, and monitoring liver fibrosis. In this comprehensive review, we first delved into the current landscape of non‐invasive imaging technologies, assessing their accuracy and the transformative impact they have had on the diagnosis and management of liver fibrosis in both clinical practice and animal models. Additionally, we provided an in‐depth exploration of recent advancements in ultrasound imaging, computed tomography imaging, magnetic resonance imaging, nuclear medicine imaging, radiomics, and artificial intelligence within the field of liver fibrosis research. We summarized the key concepts, advantages, limitations, and diagnostic performance of each technique. Finally, we discussed the challenges associated with clinical implementation and offer our perspective on advancing the field, hoping to provide alternative directions for the future research.

Conventional and artificial intelligence-based computed tomography and magnetic resonance imaging quantitative techniques for non-invasive liver fibrosis staging

Chronic liver disease (CLD) ultimately develops into liver fibrosis and cirrhosis and is a major public health problem globally. The assessment of liver fibrosis is important for patients with CLD for prognostication, treatment decisions, and surveillance. Liver biopsies are traditionally performed to determine the stage of liver fibrosis. However, the risks of complications and technical limitations restrict their application to screening and sequential monitoring in clinical practice. CT and MRI are essential for evaluating cirrhosis-associated complications in patients with CLD, and several non-invasive methods based on them have been proposed. Artificial intelligence (AI) techniques have also been applied to stage liver fibrosis. This review aimed to explore the values of conventional and AI-based CT and MRI quantitative techniques for non-invasive liver fibrosis staging and summarized their diagnostic performance, advantages, and limitations.

Lymph node detection in CT scans using modified U-Net with residual learning and 3D deep network

PURPOSE

Lymph node (LN) detection is a crucial step that complements the diagnosis and treatments involved during cancer investigations. However, the low-contrast structures in the CT scan images and the nodes' varied shapes, sizes, and poses, along with their sparsely distributed locations, make the detection step challenging and lead to many false positives. The manual examination of the CT scan slices could be time-consuming, and false positives could divert the clinician's focus. To overcome these issues, our work aims at providing an automated framework for LNs detection in order to obtain more accurate detection results with low false positives.

METHODS

The proposed work consists of two stages: candidate generation and false positive reduction. The first stage generates volumes of interest (VOI) of probable LN candidates using a modified U-Net with ResNet architecture to obtain high sensitivity but with the cost of increased false positives. The second-stage processes the obtained candidate LNs for false positive reduction using 3D convolutional neural network (CNN) classifier. We further present an analysis of various deep learning models while decomposing 3D VOI into different representations.

RESULTS

The method is evaluated on two publicly available datasets containing CT scans of mediastinal and abdominal LNs. Our proposed approach yields sensitivities of 87% at 2.75 false positives per volume (FP/vol.) and 79% at 1.74 FP/vol. with the mediastinal and abdominal datasets, respectively. Our method presented a competitive performance in terms of sensitivity compared to the state-of-the-art methods and encountered very few false positives.

CONCLUSION

We developed an automated framework for LNs detection using a modified U-Net with residual learning and 3D CNNs. The results indicate that our method could achieve high sensitivity with relatively low false positives, which helps avoid ineffective treatments.

Development of a classification method for mild liver fibrosis using non-contrast CT image

PURPOSE

Detection of early-stage liver fibrosis has direct clinical implications on patient management and treatment. The aim of this paper is to develop a non-invasive, cost-effective method for classifying liver disease between "non-fibrosis" (F0) and "fibrosis" (F1-F4), and to evaluate the classification performance quantitatively.

METHODS

Image data from 75 patients who underwent a simultaneous liver biopsy and non-contrast CT examination were used for this study. Non-contrast CT image texture features such as wavelet-based features, standard deviation of variance filter, and mean CT number were calculated in volumes of interest (VOIs) positioned within the liver parenchyma. In addition, a combined feature was calculated using logistic regression with L2-norm regularization to further improve fibrosis detection. Based on the final pathology from the liver biopsy, the patients were labelled either as "non-fibrosis" or "fibrosis". Receiver-operating characteristic (ROC) curve, area under the ROC curve (AUROC), specificity, sensitivity, and accuracy were determined for the algorithm to differentiate between "non-fibrosis" and "fibrosis".

RESULTS

The combined feature showed the highest classification performance with an AUROC of 0.86, compared to the wavelet-based feature (AUROC, 0.76), the standard deviation of variance filter (AUROC, 0.65), and mean CT number (AUROC, 0.84). The combined feature's specificity, sensitivity, and accuracy were 0.66, 0.88, and 0.76, respectively, showing the most promising results.

CONCLUSION

A new non-invasive and cost-effective method was developed to classify liver diseases between "non-fibrosis" (F0) and "fibrosis" (F1-F4). The proposed method makes it possible to detect liver fibrosis in asymptomatic patients using non-contrast CT images for better patient management and treatment.