Deep learning with ultrasonography: automated classification of liver fibrosis using a deep convolutional neural network



The aim of this study was to develop a deep convolutional neural network (DCNN) for the prediction of the METAVIR score using B-mode ultrasonography images.


Datasets from two tertiary academic referral centers were used. A total of 13,608 ultrasonography images from 3446 patients who underwent surgical resection, biopsy, or transient elastography were used for training a DCNN for the prediction of the METAVIR score. Pathological specimens or estimated METAVIR scores derived from transient elastography were used as a reference standard. A four-class model (F0 vs. F1 vs. F23 vs. F4) was developed. Diagnostic performance of the algorithm was validated on a separate internal test set of 266 patients with 300 images and external test set of 572 patients with 1232 images. Performance in classification of cirrhosis was compared between the DCNN and five radiologists.


The accuracy of the four-class model was 83.5% and 76.4% on the internal and external test set, respectively. The area under the receiver operating characteristic curve (AUC) for classification of cirrhosis (F4) was 0.901 (95% confidence interval [CI], 0.865–0.937) on the internal test set and 0.857 (95% CI, 0.825–0.889) on the external test set, respectively. The AUC of the DCNN for classification of cirrhosis (0.857) was significantly higher than that of all five radiologists (AUC range, 0.656–0.816; p value < 0.05) using the external test set.


The DCNN showed high accuracy for determining METAVIR score using ultrasonography images and achieved better performance than that of radiologists in the diagnosis of cirrhosis.

Key Points

DCNN accurately classified the ultrasonography images according to the METAVIR score.

The AUROC of this algorithm for cirrhosis assessment was significantly higher than that of radiologists.

DCNN using US images may offer an alternative tool for monitoring liver fibrosis.

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Area under the receiver operating characteristic curve


Confidence interval


Chronic liver disease


Computed tomography


Deep convolutional neural network


Digital Imaging and Communications in Medicine


Magnetic resonance


Samsung Medical Center


Seoul National University Hospital


Transient elastography




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Correspondence to Tae Wook Kang.

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The scientific guarantor of this publication is Won Jae Lee.

Conflict of interest

Won-Chul Bang, Jonghyun Yi, Gunwoo Lee, and Choonghwan Choi received support in the form of salaries from Samsung Electronics. All other authors declare that they have no conflicts of interest.

Statistics and biometry

One (Kyunga Kim) of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.


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• multicenter study

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Lee, J.H., Joo, I., Kang, T.W. et al. Deep learning with ultrasonography: automated classification of liver fibrosis using a deep convolutional neural network. Eur Radiol 30, 1264–1273 (2020).

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  • Liver
  • Ultrasonography
  • Fibrosis
  • Deep learning