Intrastrategy and interstrategy comparisons of DLRE and 2D-SWE for their relationship of diagnostic accuracy versus the number of image/measurement acquisitions in assessing liver fibrosis stages in training and validation cohorts
| n (P) | AUC | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | LR+ | LR− | ||
| Cirrhosis (F4) | |||||||||
| DLRE | |||||||||
| 1 image | T | 266 (24.8%) | 0.94** (0.91 to 0.97) | 95.5 (94.2 to 96.8) | 84.5 (79.6 to 89.4) | 67.0 (60.4 to 73.8) | 98.3 (96.1 to 99.6) | 6.2 (5.8 to 6.4) | 0.1 (0.0 to 0.1) |
| V | 132 (24.2%) | 0.84*** (0.81 to 0.87) | 75.0 (72.6 to 77.4) | 82.0 (77.3 to 86.7) | 57.1 (50.4 to 63.4) | 91.1 (85.4 to 97.2) | 4.2 (3.9 to 4.3) | 0.3 (0.3 to 0.4) | |
| 3 images | T | 266 (24.8%) | 1.00 (0.98 to 1.00) | 100.0 (98.0 to 100.0) | 100.0 (98.0 to 100.0) | 100.0 (99.0 to 100.0) | 100.0 (99.0 to 100.0) | – | 0.0 (0.0 to 0.0) |
| V | 132 (24.2%) | 0.96 (0.93 to 0.98) | 84.4 (76.9 to 91.9) | 95.0 (91.2 to 98.7) | 84.4 (78.5 to 90.1) | 95.0 (90.1 to 98.9) | 16.9 (14.9 to 18.6) | 0.2 (0.1 to 0.2) | |
| 5 images | T | 266 (24.8%) | 1.00 (0.99 to 1.00) | 100.0 (98.0 to 100.0) | 100.0 (98.0 to 100.0) | 100.0 (99.0 to 100.0) | 100.0 (99.0 to 100.0) | – | 0.0 (0.0 to 0.0) |
| V | 132 (24.2%) | 0.97 (0.94 to 0.99) | 96.9 (94.7 to 99.1) | 88.0 (82.8 to 92.2) | 72.1 (65.8 to 79.1) | 98.9 (94.8 to 99.7) | 8.1 (7.9 to 8.3) | 0.0 (0.0 to 0.1) | |
| 2D-SWE | |||||||||
| 1 measurement | T | 266 (24.8%) | 0.87****** (0.83 to 0.91) | 84.9 (73.9 to 92.5) | 75.5 (68.9 to 81.3) | 53.3 (43.3 to 63.1) | 93.8 (88.9 to 97.0) | 3.5 (3.0 to 3.9) | 0.2 (0.1 to 0.4) |
| V | 132 (24.2%) | 0.86 (0.78 to 0.91) | 93.8 (79.2 to 99.2) | 74.0 (64.3 to 82.3) | 53.6 (39.7 to 67.0) | 97.4 (90.8 to 99.7) | 3.6 (3.1 to 4.2) | 0.1 (0.0 to 0.3) | |
| 3 measurements | T | 266 (24.8%) | 0.88****** (0.83 to 0.92) | 86.4 (75.7 to 93.6) | 74.5 (67.9 to 80.4) | 52.8 (42.9 to 62.5) | 94.3 (89.5 to 97.4) | 3.4 (3.0 to 3.8) | 0.2 (0.1 to 0.4) |
| V | 132 (24.2%) | 0.85***** (0.78 to 0.91) | 87.5 (71.0 to 96.5) | 76.0 (66.4 to 84.0) | 53.8 (39.5 to 67.8) | 95.0 (87.7 to 98.6) | 3.7 (3.1 to 4.3) | 0.2 (0.1 to 0.4) | |
| 5 measurements | T | 266 (24.8%) | 0.87****** (0.83 to 0.91) | 80.3 (68.7 to 89.1) | 79.0 (72.7 to 84.4) | 55.8 (45.2 to 66.0) | 92.4 (87.4 to 95.9) | 3.8 (3.3 to 4.4) | 0.3 (0.1 to 0.4) |
| V | 132 (24.2%) | 0.86***** (0.79 to 0.92) | 87.5 (71.0 to 96.5) | 76.0 (66.4 to 84.0) | 53.8 (39.5 to 67.8) | 95.0 (87.7 to 98.6) | 3.7 (3.1 to 4.3) | 0.2 (0.1 to 0.4) | |
| Advanced fibrosis (≥F3) | |||||||||
| DLRE | |||||||||
| 1 image | T | 266 (83.8%) | 0.91* (0.86 to 0.95) | 86.8 (81.2 to 92.4) | 81.7 (76.4 to 87.1) | 86.2 (80.6 to 91.5) | 82.5 (77.1 to 87.5) | 4.8 (4.2 to 5.3) | 0.2 (0.1 to 0.2) |
| V | 132 (83.3%) | 0.82** (0.75 to 0.89) | 75.3 (70.3 to 80.3) | 79.7 (71.4 to 87.7) | 82.1 (77.0 to 87.6) | 72.3 (67.1 to 77.9) | 3.7 (3.5 to 3.9) | 0.3 (0.3 to 0.3) | |
| 3 images | T | 266 (83.8%) | 0.96 (0.92 to 0.99) | 90.1 (86.8 to 93.4) | 88.7 (82.3 to 95.1) | 91.3 (83.8 to 97.3) | 81.2 (74.8 to 87.6) | 8.0 (7.7 to 8.2) | 0.1 (0.1 to 0.1) |
| V | 132 (83.3%) | 0.95 (0.91 to 0.98) | 94.5 (90.8 to 98.2) | 86.4 (81.2 to 91.6) | 89.6 (82.5 to 95.6) | 92.7 (87.5 to 96.8) | 7.0 (6.5 to 7.4) | 0.1 (0.1 to 0.1) | |
| 5 images | T | 266 (83.8%) | 0.99 (0.97 to 1.00) | 97.4 (93.2 to 99.1) | 95.7 (91.4 to 98.6) | 95.6 (90.2 to 97.8) | 71.9 (63.8 to 78.5) | 22.4 (21.5 to 23.3) | 0.0 (0.0 to 0.0) |
| V | 132 (83.3%) | 0.98 (0.96 to 1.00) | 90.4 (84.2 to 94.6) | 98.3 (95.3 to 99.3) | 98.5 (95.8 to 99.8) | 89.2 (83.5 to 94.5) | 53.3 (51.0 to 55.3) | 0.1 (0.1 to 0.1) | |
| 2D-SWE | |||||||||
| 1 measurement | T | 266 (83.8%) | 0.81****** (0.75 to 0.82) | 72.2 (64.3 to 79.2) | 75.7 (66.8 to 83.2) | 79.6 (71.8 to 86.0) | 67.4 (58.6 to 75.5) | 3.0 (2.6 to 3.4) | 0.4 (0.2 to 0.6) |
| V | 132 (83.3%) | 0.83 (0.75 to 0.89) | 68.5 (56.6 to 78.9) | 89.8 (79.2 to 96.2) | 89.3 (78.0 to 96.0) | 69.7 (58.1 to 79.8) | 6.7 (5.6 to 8.0) | 0.4 (0.2 to 0.8) | |
| 3 measurements | T | 266 (83.8%) | 0.81****** (0.75 to 0.85) | 80.79 (73.6 to 86.7) | 68.7 (59.4 to 77.0) | 77.2 (69.9 to 83.5) | 73.1 (63.7 to 81.3) | 2.6 (2.2 to 3.0) | 0.3 (0.2 to 0.4) |
| V | 132 (83.3%) | 0.84***** (0.77 to 0.90) | 78.1 (66.9 to 86.9) | 79.7 (67.2 to 89.0) | 82.6 (71.5 to 90.7) | 74.6 (61.9 to 84.8) | 3.8 (3.2 to 4.6) | 0.3 (0.1 to 0.5) | |
| 5 measurements | T | 266 (56.8%) | 0.81****** (0.75 to 0.85) | 81.5 (74.3 to 87.3) | 70.4 (61.2 to 78.6) | 78.3 (71.1 to 84.5) | 74.3 (65.0 to 82.2) | 2.8 (2.4 to 3.2) | 0.3 (0.2 to 0.4) |
| V | 132 (55.3%) | 0.85****** (0.78 to 0.90) | 79.5 (68.4 to 88.0) | 78.0 (65.3 to 87.7) | 81.7 (70.6 to 89.9) | 75.4 (62.7 to 85.5) | 3.6 (3.0 to 4.3) | 0.3 (0.1 to 0.5) | |
| Significance fibrosis (≥F2) | |||||||||
| DLRE | |||||||||
| 1 image | T | 266 (83.8%) | 0.95 (0.93 to 0.97) | 89.7 (83.5 to 95.9) | 93.0 (87.5 to 98.5) | 98.5 (95.7 to 99.7) | 63.5 (58.4 to 68.1) | 12.9 (11.6 to 13.5) | 0.1 (0.1 to 0.1) |
| V | 132 (83.3%) | 0.74 (0.68 to 0.79) | 76.4 (71.3 to 81.5) | 72.7 (68.1 to 77.3) | 93.3 (96.7 to 98.1) | 38.1 (35.5 to 40.5) | 2.8 (2.7 to 2.9) | 0.3 (0.3 to 0.4) | |
| 3 images | T | 266 (83.8%) | 0.97 (0.94 to 0.99) | 97.8 (92.4 to 99.9) | 95.3 (92.5 to 98.1) | 99.1 (97.2 to 99.9) | 89.1 (83.4 to 94.5) | 21.0 (19.8 to 22.2) | 0.0 (0.0 to 0.0) |
| V | 132 (83.3%) | 0.82 (0.78 to 0.86) | 67.3 (62.6 to 72.1) | 95.5 (91.8 to 99.1) | 98.7 (95.8 to 99.7) | 36.8 (34.8 to 38.4) | 14.8 (13.4 to 16.0) | 0.3 (0.3 to 0.4) | |
| 5 images | T | 266 (83.8%) | 0.99 (0.97 to 1.00) | 100.0 (99.0 to 100.0) | 97.7 (92.5 to 99.3) | 99.5 (97.8 to 99.9) | 51.2 (48.5 to 53.9) | 43.0 (41.8 to 44.5) | 0.0 (0.0 to 0.0) |
| V | 132 (83.3%) | 0.85 (0.81 to 0.89) | 69.1 (64.3 to 73.5) | 90.9 (83.6 to 96.7) | 97.4 (96.8 to 99.7) | 37.0 (35.8 to 38.1) | 7.6 (6.9 to 8.4) | 0.3 (0.3 to 0.4) | |
| 2D-SWE | |||||||||
| 1 measurement | T | 266 (83.8%) | 0.72****** (0.66 to 0.77) | 59.2 (52.4 to 65.7) | 79.1 (64.0 to 90.0) | 93.6 (88.2 to 97.0) | 27.2 (19.6 to 35.9) | 2.8 (2.3 to 3.4) | 0.5 (0.3 to 0.9) |
| V | 132 (83.3%) | 0.76 (0.67 to 0.83) | 60.0 (50.2 to 69.2) | 86.4 (65.1 to 97.1) | 95.7 (87.7 to 99.1) | 30.2 (19.2 to 43.0) | 4.4 (3.5 to 5.5) | 0.5 (0.2 to 1.4) | |
| 3 measurements | T | 266 (83.8%) | 0.74****** (0.68 to 0.79) | 54.3 (47.5 to 60.9) | 83.7 (69.3 to 93.2) | 94.5 (89.0 to 97.8) | 26.1 (19.0 to 34.2) | 3.3 (2.8 to 4.0) | 0.6 (0.3 to 1.1) |
| V | 132 (83.3%) | 0.77 (0.69 to 0.84) | 51.8 (42.1 to 61.4) | 95.5 (77.2 to 99.9) | 98.3 (90.7 to 100.0) | 28.4 (18.5 to 40.1) | 11.4 (9.3 to 14.0) | 0.5 (0.1 to 3.5) | |
| 5 measurements | T | 266 (83.8%) | 0.74****** (0.68 to 0.79) | 50.7 (43.9 to 57.4) | 88.4 (74.9 to 96.1) | 95.8 (90.4 to 98.6) | 25.7 (18.8 to 33.5) | 4.4 (3.7 to 5.2) | 0.6 (0.2 to 1.3) |
| V | 132 (83.3%) | 0.77 (0.69 to 0.84) | 49.1 (39.4 to 58.8) | 95.5 (77.2 to 99.9) | 98.2 (90.2 to 100.0) | 27.3 (17.7 to 38.7) | 10.8 (8.7 to 13.3) | 0.5 (0.1 to 3.7) | |
Statistical quantifications were demonstrated with 95% CI, when applicable.
Intrastrategy comparison: for either DLRE or 2D-SWE, AUCs obtained by analysing three images/measurements were compared with these obtained by analysing one and five images/measurements, respectively (*P<0.05; **P<0.01; ***P<0.001).
Interstrategy comparison: for using the same number of images/measurements, AUCs obtained by DLRE were compared with these obtained by 2D-SWE in each liver fibrosis classification, respectively (****P<0.05; *****P<0.01; ******P<0.001).
2D-SWE, two-dimensional shear wave elastography; AUC, area under the receiver operating characteristic curve; DLRE, deep learning Radiomics of elastography; LR+, positive diagnostic likelihood ratio; LR−, negative diagnostic likelihood ratio; n, number of patients; NPV, negative predictive value; P, prevalence; PPV, positive predictive value; T, training cohort; V, validation cohort.