Liver fibrosis staging by computed tomography: Prospective randomized multicentric evaluation of image analyses

Abstract

Aim: Liver fibrosis staging is essential. We prospectively evaluated the liver fibrosis staging performance of computed tomography (CT).

Methods: 70 hepato-gastroenterology clinicians were randomized into three stratified groups with different image analyses of radiological semiology, i.e., on raw images (group 1) and on expert-annotated (group 2) and computerized-morphometry-enriched (group 3) images. Radiological fibrosis staging based on seven simple descriptors into four stages equivalent to Metavir stages (F0/1, F2, F3, F4=cirrhosis) was determined at baseline and after image analyses in 10 patients with chronic liver diseases (two per F) concordant for four independent fibrosis stagings including Metavir. 23,800 CT images were analysed, providing 1400 fibrosis stagings.

Results: Fibrosis staging: overall (3 groups) accuracy (correct classification rate) was, baseline: 43%, post-analysis: 60% (p < 0.001) without significant progression in group 1 (6%, p = 0.207) contrary to groups 2 (34%, p < 0.001) and 3 (13%, p = 0.007). Cirrhosis diagnosis: overall accuracy was, baseline: 84%, post-analysis: 89% (p < 0.001) without significant progression in group 1 (0%, p = 1) contrary to groups 2 (8%, p = 0.009) and 3 (7%, p = 0.015). Baseline AUROCs were good (≥0.83) for marked fibrosis (F≥3 or cirrhosis) in all groups. Post-analysis AUROCs became excellent (≥0.89) in group 2 for all diagnostic targets (≥0.98 for F≥3 and cirrhosis) and in group 3 for cirrhosis. In post-analysis group 2, discrimination between all F was excellent (especially, F1 from F0) with an Obuchowski index at 0.87. Negative and positive predictive values for marked fibrosis were 98% and 95%, respectively.

Conclusion: Simple CT descriptors accurately discriminate all Metavir liver fibrosis stages.

Keywords: Cirrhosis; Computed tomography; Liver fibrosis; Non-invasive diagnosis; Staging.