CT-based Deep Learning Model for Automatic Segmentation and Early Predicting of Pyogenic Liver Abscess Caused by Extended-Spectrum β-lactamase-Producing Enterobacteriaceae: A Multicenter Retrospective Study (CLASS2401).

RATIONALE AND OBJECTIVE: Pyogenic liver abscess (PLA) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PLA) presents major antimicrobial treatment challenges and delayed pathogen identification. This study developed and validated deep learning-based models integrating clinical and CT imaging features for early prediction of ESBL-PLA prior to microbiological confirmation. MATERIALS AND METHODS: This retrospective multicenter study included 442 patients from 6 centers in China, divided into training, internal test, and external test sets (n = 211, 111, and 120, respectively). An automated PLA segmentation model based on nnUNetv2 was developed using expert-annotated lesions. Clinical, radiomics, and deep learning imaging features were used to construct predictive basic models. Two combined models, the clinical-radiomics model and clinical-imaging model (CIM) were constructed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and other metrics. RESULTS: The segmentation model achieved high Dice similarity coefficient values across datasets. The CIM showed strong predictive performance for ESBL-PLA, with AUCs of 0.945, 0.889, and 0.844 in the training, internal test, and external test sets, respectively. At the optimal cutoff (0.663), the CIM achieved positive predictive values of 95.2%, 86.6%, and 70.7%, and negative predictive values of 95.0%, 96.3%, and 95.7% in the training, internal test, and external test sets, respectively. And the high-risk group had a significantly higher incidence of ESBL-PLA (74.58%) than the low-risk group (6.00%, P < 0.001). CONCLUSIONS: Deep learning-based radiomics enables early imaging-based prediction of ESBL-PLA and may support imaging-based risk stratification for infections caused by multidrug-resistant pathogens.