Fully Automated Deep Learning-enabled Detection for Hepatic Steatosis on Computed Tomography: A Multicenter International Validation Study

Despite high global prevalence of hepatic steatosis, no automated diagnostics demonstrated generalizability in detecting steatosis on multiple international datasets. Traditionally, hepatic steatosis detection relies on clinicians selecting the region of interest (ROI) on computed tomography (CT) to measure liver attenuation. ROI selection demands time and expertise, and therefore is not routinely performed in populations. To automate the process, we validated an existing artificial intelligence (AI) system for 3D liver segmentation and used it to purpose a novel method: AI-ROI, which could automatically select the ROI for attenuation measurements. AI segmentation and AI-ROI method were evaluated on 1,014 non-contrast enhanced chest CT images from eight international datasets: LIDC-IDRI, NSCLC-Lung1, RIDER, VESSEL12, RICORD-1A, RICORD-1B, COVID-19-Italy, and COVID-19-China. AI segmentation achieved a mean dice coefficient of 0.957. Attenuations measured by AI-ROI showed no significant differences (p = 0.545) and a reduction of 71% time compared to expert measurements. The area under the curve (AUC) of the steatosis classification of AI-ROI is 0.921 (95% CI: 0.883 - 0.959). If performed as a routine screening method, our AI protocol could potentially allow early non-invasive, non-pharmacological preventative interventions for hepatic steatosis. 1,014 expert-annotated liver segmentations of patients with hepatic steatosis annotations can be downloaded here: https://drive.google.com/drive/folders/1-g_zJeAaZXYXGqL1OeF6pUjr6KB0igJX.