Development and Validation of a Deep Learning System for Staging Liver Fibrosis by Using Contrast Agent-enhanced CT Images in the Liver.

Journal: Radiology
Published Date: Dec 1, 2018

Abstract

Purpose To develop and validate a deep learning system (DLS) for staging liver fibrosis by using CT images in the liver. Materials and Methods DLS for CT-based staging of liver fibrosis was created by using a development data set that included portal venous phase CT images in 7461 patients with pathologically confirmed liver fibrosis. The diagnostic performance of the DLS was evaluated in separate test data sets for 891 patients. The influence of patient characteristics and CT techniques on the staging accuracy of the DLS was evaluated by logistic regression analysis. In a subset of 421 patients, the diagnostic performance of the DLS was compared with that of the radiologist's assessment, aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 index by using the area under the receiver operating characteristic curve (AUROC) and Obuchowski index. Results In the test data sets, the DLS had a staging accuracy of 79.4% (707 of 891) and an AUROC of 0.96, 0.97, and 0.95 for diagnosing significant fibrosis (F2-4), advanced fibrosis (F3-4), and cirrhosis (F4), respectively. At multivariable analysis, only pathologic fibrosis stage significantly affected the staging accuracy of the DLS (P = .016 and .013 for F1 and F2, respectively, compared with F4), whereas etiology of liver disease and CT technique did not. The DLS (Obuchowski index, 0.94) outperformed the radiologist's interpretation, APRI, and fibrosis-4 index (Obuchowski index range, 0.71-0.81; P ˂ .001) for staging liver fibrosis. Conclusion The deep learning system allows for accurate staging of liver fibrosis by using CT images. © RSNA, 2018 Online supplemental material is available for this article.

Authors

  • Kyu Jin Choi
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Jong Keon Jang
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Seung Soo Lee
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Yu Sub Sung
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Woo Hyun Shim
    Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
  • Ho Sung Kim
    Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
  • Jessica Yun
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Jin-Young Choi
  • Yedaun Lee
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Bo-Kyeong Kang
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).
  • Jin Hee Kim
  • So Yeon Kim
  • Eun Sil Yu
    From the Department of Computer Science, Hanyang University, Seoul, Republic of Korea (K.J.C.); Department of Radiology and Research Institute of Radiology (J.K.J., S.S.L., Y.S.S., W.H.S., H.S.K., J.Y., J.H.K., S.Y.K.) and Department of Diagnostic Pathology (E.S.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (J.Y.C.); Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea (B.K.K.).

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