Deep-learning-based prediction of significant portal hypertension with single cross-sectional non-enhanced CT

The purpose of this study was to establish a predictive deep learning (DL) model for clinically significant portal hypertension (CSPH) based on a single cross-sectional non-contrast CT image and to compare four representative positional images to determine the most suitable for the detection of CSPH.

The study included 421 patients with chronic liver disease who underwent hepatic venous pressure gradient measurement at our institution between May 2007 and January 2024. Patients were randomly classified into training, validation, and test datasets at a ratio of 8:1:1. Non-contrast cross-sectional CT images from four target areas of interest were used to create four deep-learning-based models for predicting CSPH. The areas of interest were the umbilical portion of the portal vein (PV), the first right branch of the PV, the confluence of the splenic vein and PV, and the maximum cross-section of the spleen. The models were implemented using convolutional neural networks with a multilayer perceptron as the classifier. The model with the best predictive ability for CSPH was then compared to 13 conventional evaluation methods.

Among the four areas, the umbilical portion of the PV had the highest predictive ability for CSPH (area under the curve [AUC]: 0.80). At the threshold maximizing the Youden index, sensitivity and specificity were 0.867 and 0.615, respectively. This DL model outperformed the ANTICIPATE model.

We developed an algorithm that can predict CSPH immediately from a single slice of non-contrast CT, using the most suitable image of the umbilical portion of the PV.

Question CSPH predicts complications but requires invasive hepatic venous pressure gradient measurement for diagnosis. Findings At the threshold maximizing the Youden index, sensitivity and specificity were 0.867 and 0.615, respectively. This DL model outperformed the ANTICIPATE model. Clinical relevance This study shows that a DL model can accurately predict CSPH from a single non-contrast CT image, providing a non-invasive alternative to invasive methods and aiding early detection and risk stratification in chronic liver disease without image manipulation.