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Chatzipanagiotou OP, Loukas C, Vailas M, Machairas N, Kykalos S, Charalampopoulos G, Filippiadis D, Felekouras E, Schizas D. Artificial intelligence in hepatocellular carcinoma diagnosis: a comprehensive review of current literature. J Gastroenterol Hepatol 2024. [PMID: 38923550 DOI: 10.1111/jgh.16663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND AIM Hepatocellular carcinoma (HCC) diagnosis mainly relies on its pathognomonic radiological profile, obviating the need for biopsy. The project of incorporating artificial intelligence (AI) techniques in HCC aims to improve the performance of image recognition. Herein, we thoroughly analyze and evaluate proposed AI models in the field of HCC diagnosis. METHODS A comprehensive review of the literature was performed utilizing MEDLINE/PubMed and Web of Science databases with the end of search date being the 30th of September 2023. The MESH terms "Artificial Intelligence," "Liver Cancer," "Hepatocellular Carcinoma," "Machine Learning," and "Deep Learning" were searched in the title and/or abstract. All references of the obtained articles were also evaluated for any additional information. RESULTS Our search resulted in 183 studies meeting our inclusion criteria. Across all diagnostic modalities, reported area under the curve (AUC) of most developed models surpassed 0.900. A B-mode US and a contrast-enhanced US model achieved AUCs of 0.947 and 0.957, respectively. Regarding the more challenging task of HCC diagnosis, a 2021 deep learning model, trained with CT scans, classified hepatic malignant lesions with an AUC of 0.986. Finally, a MRI machine learning model developed in 2021 displayed an AUC of 0.975 when differentiating small HCCs from benign lesions, while another MRI-based model achieved HCC diagnosis with an AUC of 0.970. CONCLUSIONS AI tools may lead to significant improvement in diagnostic management of HCC. Many models fared better or comparable to experienced radiologists while proving capable of elevating radiologists' accuracy, demonstrating promising results for AI implementation in HCC-related diagnostic tasks.
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Affiliation(s)
- Odysseas P Chatzipanagiotou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Constantinos Loukas
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Georgios Charalampopoulos
- Second Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Filippiadis
- Second Department of Radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Evangellos Felekouras
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Dai H, Xiao Y, Fu C, Grimm R, von Busch H, Stieltjes B, Choi MH, Xu Z, Chabin G, Yang C, Zeng M. Deep Learning-Based Approach for Identifying and Measuring Focal Liver Lesions on Contrast-Enhanced MRI. J Magn Reson Imaging 2024. [PMID: 38826142 DOI: 10.1002/jmri.29404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The number of focal liver lesions (FLLs) detected by imaging has increased worldwide, highlighting the need to develop a robust, objective system for automatically detecting FLLs. PURPOSE To assess the performance of the deep learning-based artificial intelligence (AI) software in identifying and measuring lesions on contrast-enhanced magnetic resonance imaging (MRI) images in patients with FLLs. STUDY TYPE Retrospective. SUBJECTS 395 patients with 1149 FLLs. FIELD STRENGTH/SEQUENCE The 1.5 T and 3 T scanners, including T1-, T2-, diffusion-weighted imaging, in/out-phase imaging, and dynamic contrast-enhanced imaging. ASSESSMENT The diagnostic performance of AI, radiologist, and their combination was compared. Using 20 mm as the cut-off value, the lesions were divided into two groups, and then divided into four subgroups: <10, 10-20, 20-40, and ≥40 mm, to evaluate the sensitivity of radiologists and AI in the detection of lesions of different sizes. We compared the pathologic sizes of 122 surgically resected lesions with measurements obtained using AI and those made by radiologists. STATISTICAL TESTS McNemar test, Bland-Altman analyses, Friedman test, Pearson's chi-squared test, Fisher's exact test, Dice coefficient, and intraclass correlation coefficients. A P-value <0.05 was considered statistically significant. RESULTS The average Dice coefficient of AI in segmentation of liver lesions was 0.62. The combination of AI and radiologist outperformed the radiologist alone, with a significantly higher detection rate (0.894 vs. 0.825) and sensitivity (0.883 vs. 0.806). The AI showed significantly sensitivity than radiologists in detecting all lesions <20 mm (0.848 vs. 0.788). Both AI and radiologists achieved excellent detection performance for lesions ≥20 mm (0.867 vs. 0.881, P = 0.671). A remarkable agreement existed in the average tumor sizes among the three measurements (P = 0.174). DATA CONCLUSION AI software based on deep learning exhibited practical value in automatically identifying and measuring liver lesions. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Haoran Dai
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyao Xiao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Robert Grimm
- MR Predevelopment, Siemens Healthineers AG, Erlangen, Germany
| | - Heinrich von Busch
- Innovation Owner Artificial Intelligence for Oncology, Siemens Healthineers AG, Erlangen, Germany
| | | | - Moon Hyung Choi
- Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Zhoubing Xu
- Technology Excellence, Digital Technology and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Guillaume Chabin
- Technology Excellence, Digital Technology and Innovation, Siemens Healthecare SAS, Paris, France
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
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Wang Z, Yao J, Jing X, Li K, Lu S, Yang H, Ding H, Li K, Cheng W, He G, Jiang T, Liu F, Yu J, Han Z, Cheng Z, Tan S, Wang Z, Qi E, Wang S, Zhang Y, Li L, Dong X, Liang P, Yu X. A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study. Abdom Radiol (NY) 2024:10.1007/s00261-024-04253-4. [PMID: 38744698 DOI: 10.1007/s00261-024-04253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). METHODS A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. RESULTS Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. CONCLUSION The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.
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Affiliation(s)
- Zhen Wang
- Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jundong Yao
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
- Department of Ultrasound, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShiChun Lu
- Department of Hepatobiliary Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hong Yang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, China
| | - Guangzhi He
- Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, Guangming District, Shenzhen, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Shuilian Tan
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Zhen Wang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Erpeng Qi
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Shuo Wang
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - YiQiong Zhang
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Lu Li
- Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Xiaocong Dong
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China.
| | - Xiaoling Yu
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
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Lu F, Meng Y, Song X, Li X, Liu Z, Gu C, Zheng X, Jing Y, Cai W, Pinyopornpanish K, Mancuso A, Romeiro FG, Méndez-Sánchez N, Qi X. Artificial Intelligence in Liver Diseases: Recent Advances. Adv Ther 2024; 41:967-990. [PMID: 38286960 DOI: 10.1007/s12325-024-02781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 01/31/2024]
Abstract
Liver diseases cause a significant burden on public health worldwide. In spite of great advances during recent years, there are still many challenges in the diagnosis and treatment of liver diseases. During recent years, artificial intelligence (AI) has been widely used for the diagnosis, risk stratification, and prognostic prediction of various diseases based on clinical datasets and medical images. Accumulative studies have shown its performance for diagnosing patients with nonalcoholic fatty liver disease and liver fibrosis and assessing their severity, and for predicting treatment response and recurrence of hepatocellular carcinoma, outcomes of liver transplantation recipients, and risk of drug-induced liver injury. Herein, we aim to comprehensively summarize the current evidence regarding diagnostic, prognostic, and/or therapeutic role of AI in these common liver diseases.
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Affiliation(s)
- Feifei Lu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
| | - Yao Meng
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Xiaoting Song
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Xiaotong Li
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhuang Liu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Chunru Gu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Xiaojie Zheng
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Yi Jing
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China
| | - Wei Cai
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China
| | - Kanokwan Pinyopornpanish
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Andrea Mancuso
- Medicina Interna 1, Azienda di Rilievo Nazionale Ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy.
| | | | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Xingshun Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China.
- Postgraduate College, Dalian Medical University, Dalian, China.
- Postgraduate College, China Medical University, Shenyang, China.
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Wei Q, Tan N, Xiong S, Luo W, Xia H, Luo B. Deep Learning Methods in Medical Image-Based Hepatocellular Carcinoma Diagnosis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:5701. [PMID: 38067404 PMCID: PMC10705136 DOI: 10.3390/cancers15235701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 06/24/2024] Open
Abstract
(1) Background: The aim of our research was to systematically review papers specifically focused on the hepatocellular carcinoma (HCC) diagnostic performance of DL methods based on medical images. (2) Materials: To identify related studies, a comprehensive search was conducted in prominent databases, including Embase, IEEE, PubMed, Web of Science, and the Cochrane Library. The search was limited to studies published before 3 July 2023. The inclusion criteria consisted of studies that either developed or utilized DL methods to diagnose HCC using medical images. To extract data, binary information on diagnostic accuracy was collected to determine the outcomes of interest, namely, the sensitivity, specificity, and area under the curve (AUC). (3) Results: Among the forty-eight initially identified eligible studies, thirty studies were included in the meta-analysis. The pooled sensitivity was 89% (95% CI: 87-91), the specificity was 90% (95% CI: 87-92), and the AUC was 0.95 (95% CI: 0.93-0.97). Analyses of subgroups based on medical image methods (contrast-enhanced and non-contrast-enhanced images), imaging modalities (ultrasound, magnetic resonance imaging, and computed tomography), and comparisons between DL methods and clinicians consistently showed the acceptable diagnostic performance of DL models. The publication bias and high heterogeneity observed between studies and subgroups can potentially result in an overestimation of the diagnostic accuracy of DL methods in medical imaging. (4) Conclusions: To improve future studies, it would be advantageous to establish more rigorous reporting standards that specifically address the challenges associated with DL research in this particular field.
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Affiliation(s)
- Qiuxia Wei
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
| | - Nengren Tan
- School of Electronic and Information Engineering, Guangxi Normal University, 15 Qixing District, Guilin 541004, China;
| | - Shiyu Xiong
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
| | - Wanrong Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
| | - Haiying Xia
- School of Electronic and Information Engineering, Guangxi Normal University, 15 Qixing District, Guilin 541004, China;
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
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Avella P, Cappuccio M, Cappuccio T, Rotondo M, Fumarulo D, Guerra G, Sciaudone G, Santone A, Cammilleri F, Bianco P, Brunese MC. Artificial Intelligence to Early Predict Liver Metastases in Patients with Colorectal Cancer: Current Status and Future Prospectives. Life (Basel) 2023; 13:2027. [PMID: 37895409 PMCID: PMC10608483 DOI: 10.3390/life13102027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Artificial Intelligence (AI)-based analysis represents an evolving medical field. In the last few decades, several studies have reported the diagnostic efficiency of AI applied to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to early detect liver metastases (LM), mainly from colorectal cancer. Despite the increase in information and the development of different procedures in several radiological fields, an accurate method of predicting LM has not yet been found. This review aims to compare the diagnostic efficiency of different AI methods in the literature according to accuracy, sensibility, precision, and recall to identify early LM. METHODS A narrative review of the literature was conducted on PubMed. A total of 336 studies were screened. RESULTS We selected 17 studies from 2012 to 2022. In total, 14,475 patients were included, and more than 95% were affected by colorectal cancer. The most frequently used imaging tool to early detect LM was found to be CT (58%), while MRI was used in three cases. Four different AI analyses were used: deep learning, radiomics, machine learning, and fuzzy systems in seven (41.18%), five (29.41%), four (23.53%), and one (5.88%) cases, respectively. Four studies achieved an accuracy of more than 90% after MRI and CT scan acquisition, while just two reported a recall rate ≥90% (one method using MRI and CT and one CT). CONCLUSIONS Routinely acquired radiological images could be used for AI-based analysis to early detect LM. Simultaneous use of radiomics and machine learning analysis applied to MRI or CT images should be an effective method considering the better results achieved in the clinical scenario.
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Affiliation(s)
- Pasquale Avella
- HPB Surgery Unit, Pineta Grande Hospital, Castel Volturno, 81030 Caserta, Italy;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Teresa Cappuccio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Marco Rotondo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Daniela Fumarulo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Germano Guerra
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Guido Sciaudone
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | - Antonella Santone
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
| | | | - Paolo Bianco
- HPB Surgery Unit, Pineta Grande Hospital, Castel Volturno, 81030 Caserta, Italy;
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (T.C.); (M.R.); (D.F.); (G.G.); (G.S.); (A.S.); (M.C.B.)
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Wang K, Liu Y, Chen H, Yu W, Zhou J, Wang X. Fully automating LI-RADS on MRI with deep learning-guided lesion segmentation, feature characterization, and score inference. Front Oncol 2023; 13:1153241. [PMID: 37274239 PMCID: PMC10233056 DOI: 10.3389/fonc.2023.1153241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Leveraging deep learning in the radiology community has great potential and practical significance. To explore the potential of fitting deep learning methods into the current Liver Imaging Reporting and Data System (LI-RADS) system, this paper provides a complete and fully automatic deep learning solution for the LI-RADS system and investigates its model performance in liver lesion segmentation and classification. Methods To achieve this, a deep learning study design process is formulated, including clinical problem formulation, corresponding deep learning task identification, data acquisition, data preprocessing, and algorithm validation. On top of segmentation, a UNet++-based segmentation approach with supervised learning was performed by using 33,078 raw images obtained from 111 patients, which are collected from 2010 to 2017. The key innovation is that the proposed framework introduces one more step called feature characterization before LI-RADS score classification in comparison to prior work. In this step, a feature characterization network with multi-task learning and joint training strategy was proposed, followed by an inference module to generate the final LI-RADS score. Results Both liver segmentation and feature characterization models were evaluated, and comprehensive statistical analysis was conducted with detailed discussions. Median DICE of liver lesion segmentation was able to achieve 0.879. Based on different thresholds, recall changes within a range of 0.7 to 0.9, and precision always stays high greater than 0.9. Segmentation model performance was also evaluated on the patient level and lesion level, and the evaluation results of (precision, recall) on the patient level were much better at approximately (1, 0.9). Lesion classification was evaluated to have an overall accuracy of 76%, and most mis-classification cases happen in the neighboring categories, which is reasonable since it is naturally difficult to distinguish LI-RADS 4 from LI-RADS 5. Discussion In addition to investigating the performance of the proposed model itself, extensive comparison experiment was also conducted. This study shows that our proposed framework with feature characterization greatly improves the diagnostic performance which also validates the effectiveness of the added feature characterization step. Since this step could output the feature characterization results instead of simply generating a final score, it is able to unbox the black-box for the proposed algorithm thus improves the explainability.
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Affiliation(s)
- Ke Wang
- First Hospital, Peking University, Beijing, China
| | - Yuehua Liu
- Department of Precision Diagnosis & Image Guided Therapy, Philips Research, Shanghai, China
| | - Hongxin Chen
- Department of Precision Diagnosis & Image Guided Therapy, Philips Research, Shanghai, China
| | - Wenjin Yu
- Department of Precision Diagnosis & Image Guided Therapy, Philips Research, Shanghai, China
| | - Jiayin Zhou
- Department of Precision Diagnosis & Image Guided Therapy, Philips Research, Shanghai, China
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Wei J, Jiang H, Zhou Y, Tian J, Furtado FS, Catalano OA. Radiomics: A radiological evidence-based artificial intelligence technique to facilitate personalized precision medicine in hepatocellular carcinoma. Dig Liver Dis 2023:S1590-8658(22)00863-5. [PMID: 36641292 DOI: 10.1016/j.dld.2022.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/16/2023]
Abstract
The high postoperative recurrence rates in hepatocellular carcinoma (HCC) remain a major hurdle in its management. Appropriate staging and treatment selection may alleviate the extent of fatal recurrence. However, effective methods to preoperatively evaluate pathophysiologic and molecular characteristics of HCC are lacking. Imaging plays a central role in HCC diagnosis and stratification due to the non-invasive diagnostic criteria. Vast and crucial information is hidden within image data. Other than providing a morphological sketch for lesion diagnosis, imaging could provide new insights to describe the pathophysiological and genetic landscape of HCC. Radiomics aims to facilitate diagnosis and prognosis of HCC using artificial intelligence techniques to harness the immense information contained in medical images. Radiomics produces a set of archetypal and robust imaging features that are correlated to key pathological or molecular biomarkers to preoperatively risk-stratify HCC patients. Inferred with outcome data, comprehensive combination of radiomic, clinical and/or multi-omics data could also improve direct prediction of response to treatment and prognosis. The evolution of radiomics is changing our understanding of personalized precision medicine in HCC management. Herein, we review the key techniques and clinical applications in HCC radiomics and discuss current limitations and future opportunities to improve clinical decision making.
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Affiliation(s)
- Jingwei Wei
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, PR. China; Beijing Key Laboratory of Molecular Imaging, Beijing 100190, PR. China.
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR. China
| | - Yu Zhou
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, PR. China; Beijing Key Laboratory of Molecular Imaging, Beijing 100190, PR. China; School of Life Science and Technology, Xidian University, Xi'an, PR. China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, PR. China; Beijing Key Laboratory of Molecular Imaging, Beijing 100190, PR. China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, 100191, PR. China; Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, PR. China.
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States.
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9
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Rónaszéki AD, Dudás I, Zsély B, Budai BK, Stollmayer R, Hahn O, Csongrády B, Park BS, Maurovich-Horvat P, Győri G, Kaposi PN. Microvascular flow imaging to differentiate focal hepatic lesions: the spoke-wheel pattern as a specific sign of focal nodular hyperplasia. Ultrasonography 2023; 42:172-181. [PMID: 36420572 PMCID: PMC9816699 DOI: 10.14366/usg.22028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022] Open
Abstract
Microvascular flow imaging (MVFI) is an advanced Doppler ultrasound technique designed to detect slow-velocity blood flow in small-caliber microvessels. This technique is capable of realtime, highly detailed visualization of tumor vessels without using a contrast agent. MVFI has been recently applied for the characterization of focal liver lesions and has revealed typical vascularity distributions in multiple types thereof. Focal nodular hyperplasia (FNH) constitutes an important differential diagnosis of malignant liver tumors. In this essay, we provide iconographic documentation of the MVFI appearance of FNH and other common solid liver lesions. Identifying the typical patterns of vascularity, including the spoke-wheel pattern with MVFI, can expedite the diagnosis, spare patients from unnecessary procedures, and save costs.
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Affiliation(s)
- Aladár David Rónaszéki
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ibolyka Dudás
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Boglarka Zsély
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bettina Katalin Budai
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Stollmayer
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Oszkár Hahn
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara Csongrády
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Byung-so Park
- Medical Affairs Manager at Samsung Medison, Samsung Medison Co., Ltd., An Affiliate of Samsung Electronics, Seoul, Korea
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabriella Győri
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pal Novak Kaposi
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary,Correspondence to: Pál Novák Kaposi, MD, PhD, Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Korányi Sándor str. 2., H-1083 Budapest, Hungary Tel. +36-1-459-1500/61628 Fax. +36-1-459-1500/61626 E-mail:
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10
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Martinino A, Aloulou M, Chatterjee S, Scarano Pereira JP, Singhal S, Patel T, Kirchgesner TPE, Agnes S, Annunziata S, Treglia G, Giovinazzo F. Artificial Intelligence in the Diagnosis of Hepatocellular Carcinoma: A Systematic Review. J Clin Med 2022; 11:6368. [PMID: 36362596 PMCID: PMC9655417 DOI: 10.3390/jcm11216368] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 09/21/2023] Open
Abstract
Hepatocellular carcinoma ranks fifth amongst the most common malignancies and is the third most common cause of cancer-related death globally. Artificial Intelligence is a rapidly growing field of interest. Following the PRISMA reporting guidelines, we conducted a systematic review to retrieve articles reporting the application of AI in HCC detection and characterization. A total of 27 articles were included and analyzed with our composite score for the evaluation of the quality of the publications. The contingency table reported a statistically significant constant improvement over the years of the total quality score (p = 0.004). Different AI methods have been adopted in the included articles correlated with 19 articles studying CT (41.30%), 20 studying US (43.47%), and 7 studying MRI (15.21%). No article has discussed the use of artificial intelligence in PET and X-ray technology. Our systematic approach has shown that previous works in HCC detection and characterization have assessed the comparability of conventional interpretation with machine learning using US, CT, and MRI. The distribution of the imaging techniques in our analysis reflects the usefulness and evolution of medical imaging for the diagnosis of HCC. Moreover, our results highlight an imminent need for data sharing in collaborative data repositories to minimize unnecessary repetition and wastage of resources.
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Affiliation(s)
| | | | - Surobhi Chatterjee
- Department of Internal Medicine, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | | | - Saurabh Singhal
- Department of HPB Surgery and Liver Transplantation, BLK-MAX Superspeciality Hospital, New Delhi 110005, Delhi, India
| | - Tapan Patel
- Department of Surgery, Baroda Medical College and SSG Hospital, Vadodara 390001, Gujarat, India
| | - Thomas Paul-Emile Kirchgesner
- Département of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium
| | - Salvatore Agnes
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Salvatore Annunziata
- Unit of Nuclear Medicine, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgio Treglia
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Francesco Giovinazzo
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Guo J, Jiang D, Qian Y, Yu J, Gu YJ, Zhou YQ, Zhang HP. Differential diagnosis of different types of solid focal liver lesions using two-dimensional shear wave elastography. World J Gastroenterol 2022; 28:4716-4725. [PMID: 36157921 PMCID: PMC9476867 DOI: 10.3748/wjg.v28.i32.4716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical management and prognosis differ between benign and malignant solid focal liver lesions (FLLs), as well as among different pathological types of malignant FLLs. Accurate diagnosis of the possible types of solid FLLs is important. Our previous study confirmed the value of shear wave elastography (SWE) using maximal elasticity (Emax) as the parameter in the differential diagnosis between benign and malignant FLLs. However, the value of SWE in the differential diagnosis among different pathological types of malignant FLLs has not been proved.
AIM To explore the value of two-dimensional SWE (2D-SWE) using Emax in the differential diagnosis of FLLs, especially among different pathological types of malignant FLLs.
METHODS All the patients enrolled in this study were diagnosed as benign, malignant or undetermined FLLs by conventional ultrasound. Emax of FLLs and the periphery of FLLs was measured using 2D-SWE and compared between benign and malignant FLLs or among different pathological types of malignant FLLs.
RESULTS The study included 32 benign FLLs in 31 patients and 100 malignant FLLs in 96 patients, including 16 cholangiocellular carcinomas (CCCs), 72 hepatocellular carcinomas (HCCs) and 12 liver metastases. Thirty-five FLLs were diagnosed as undetermined by conventional ultrasound. There were significant differences between Emax of malignant (2.21 ± 0.57 m/s) and benign (1.59 ± 0.37 m/s) FLLs (P = 0.000), and between Emax of the periphery of malignant (1.52 ± 0.39 m/s) and benign (1.36 ± 0.44 m/s) FLLs (P = 0.040). Emax of liver metastases (2.73 ± 0.99 m/s) was significantly higher than that of CCCs (2.14 ± 0.34 m/s) and HCCs (2.14 ± 0.46 m/s) (P = 0.002). The sensitivity, specificity and accuracy were 71.00%, 84.38% and 74.24% respectively, using Emax > 1.905 m/s (AUC 0.843) to diagnose as malignant and 23 of 35 (65.74%) FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly.
CONCLUSION Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas. 2D-SWE with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.
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Affiliation(s)
- Jia Guo
- Department of Ultrasound, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Dong Jiang
- Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
| | - Yi Qian
- Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
| | - Jiao Yu
- Department of Infectious Diseases, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
| | - Yi-Jun Gu
- Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
| | - Yu-Qing Zhou
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200050, China
| | - Hui-Ping Zhang
- Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200050, China
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12
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Focal Liver Lesion MRI Feature Identification Using Efficientnet and MONAI: A Feasibility Study. Cells 2022; 11:cells11091558. [PMID: 35563862 PMCID: PMC9104155 DOI: 10.3390/cells11091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Liver tumors constitute a major part of the global disease burden, often making regular imaging follow-up necessary. Recently, deep learning (DL) has increasingly been applied in this research area. How these methods could facilitate report writing is still a question, which our study aims to address by assessing multiple DL methods using the Medical Open Network for Artificial Intelligence (MONAI) framework, which may provide clinicians with preliminary information about a given liver lesion. For this purpose, we collected 2274 three-dimensional images of lesions, which we cropped from gadoxetate disodium enhanced T1w, native T1w, and T2w magnetic resonance imaging (MRI) scans. After we performed training and validation using 202 and 65 lesions, we selected the best performing model to predict features of lesions from our in-house test dataset containing 112 lesions. The model (EfficientNetB0) predicted 10 features in the test set with an average area under the receiver operating characteristic curve (standard deviation), sensitivity, specificity, negative predictive value, positive predictive value of 0.84 (0.1), 0.78 (0.14), 0.86 (0.08), 0.89 (0.08) and 0.71 (0.17), respectively. These results suggest that AI methods may assist less experienced residents or radiologists in liver MRI reporting of focal liver lesions.
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