Computer-aided diagnosis of cirrhosis and hepatocellular carcinoma using multi-phase abdomen CT

High mortality rate due to liver cirrhosis has been reported over the globe in the previous years. Early detection of cirrhosis may help in controlling the disease progression toward hepatocellular carcinoma (HCC). The lack of trained CT radiologists and increased patient population delays the diagnosis and further management. This study proposes a computer-aided diagnosis system for detecting cirrhosis and HCC in a very efficient and less time-consuming approach.

Contrast-enhanced CT dataset of 40 patients (n = 40; M:F = 5:3; age = 25-55 years) with three groups of subjects: healthy (n = 14), cirrhosis (n = 12) and cirrhosis with HCC (n = 14), were retrospectively analyzed in this study. A novel method for the automatic 3D segmentation of liver using modified region-growing segmentation technique was developed and compared with the state-of-the-art deep learning-based technique. Further, histogram parameters were calculated from segmented CT liver volume for classification between healthy and diseased (cirrhosis and HCC) liver using logistic regression. Multi-phase analysis of CT images was performed to extract 24 temporal features for detecting cirrhosis and HCC liver using support vector machine (SVM).

The proposed method produced improved 3D segmentation with Dice coefficient 90% for healthy liver, 86% for cirrhosis and 81% for HCC subjects compared to the deep learning algorithm (healthy: 82%; cirrhosis: 78%; HCC: 70%). Standard deviation and kurtosis were found to be statistically different (p < 0.05) among healthy and diseased liver, and using logistic regression, classification accuracy obtained was 92.5%. For detecting cirrhosis and HCC liver, SVM with RBF kernel obtained highest slice-wise and patient-wise prediction accuracy of 86.9% (precision = 0.93, recall = 0.7) and 80% (precision = 0.86, recall = 0.75), respectively, than that of linear kernel (slice-wise: accuracy = 85.4%, precision = 0.92, recall = 0.67; patient-wise: accuracy = 73.33%, precision = 0.75, recall = 0.75).

The proposed computer-aided diagnosis system for detecting cirrhosis and hepatocellular carcinoma (HCC) showed promising results and can be used as effective screening tool in medical image analysis.