Diagnostic performance of DLRE, 2D-SWE, APRI and FIB-4 for the assessment of liver fibrosis stages in training and validation cohorts
| n (P) | AUC | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | LR+ | LR− | ||
| Cirrhosis (F4) | |||||||||
| DLRE | 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 (64.4 to 79.8) | 99.9 (98.4 to 100.0) | 8.1 (7.9 to 8.2) | 0.0 (0.0 to 0.1) | |
| 2D-SWE | 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) | |
| APRI | T | 266 (24.8%) | 0.69*** (0.63 to 0.75) | 63.6 (50.9 to 75.1) | 73.5 (66.8 to 79.5) | 44.2 (34.0 to 54.8) | 86.0 (79.8 to 90.8) | 2.4 (2.0 to 2.9) | 0.5 (0.3 to 0.7) |
| V | 132 (24.2%) | 0.70*** (0.62 to 0.78) | 78.1 (60.0 to 90.7) | 60.0 (49.7 to 69.7) | 38.5 (26.7 to 51.4) | 89.6 (79.7 to 95.7) | 2.0 (1.5 to 2.5) | 0.4 (0.2 to 0.7) | |
| FIB-4 | T | 266 (24.8%) | 0.73*** (0.68 to 0.78) | 63.6 (50.9 to 75.1) | 77.0 (70.5 to 82.6) | 47.7 (37.0 to 58.6) | 86.5 (80.6 to 91.2) | 2.8 (2.3 to 3.4) | 0.5 (0.3 to 0.7) |
| V | 132 (24.2%) | 0.75*** (0.66 to 0.82) | 50.0 (31.9 to 68.1) | 93.0 (86.1 to 97.1) | 69.6 (46.5 to 87.1) | 85.3 (77.3 to 91.4) | 7.1 (5.0 to 10.1) | 0.5 (0.2 to 1.2) | |
| Advanced fibrosis (≥F3) | |||||||||
| DLRE | T | 266 (56.8%) | 0.99 (0.97 to 1.00) | 97.4 (93.2 to 99.1) | 95.7 (91.4 to 98.6) | 95.6 (89.4 to 98.2) | 71.9 (63.5 to 80.1) | 22.4 (20.1 to 24.5) | 0.0 (0.0 to 0.0) |
| V | 132 (55.3%) | 0.98 (0.96 to 1.00) | 90.4 (84.2 to 94.6) | 98.3 (95.3 to 99.3) | 98.5 (93.7 to 99.7) | 89.2 (82.4 to 94.3) | 53.3 (49.7 to 57.3) | 0.1 (0.1 to 0.1) | |
| 2D-SWE | 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) | |
| APRI | T | 266 (56.8%) | 0.65*** (0.59 to 0.71) | 55.6 (47.3 to 63.7) | 74.8 (65.8 to 82.4) | 74.3 (65.2 to 82.1) | 56.2 (48.0 to 64.2) | 2.2 (1.8 to 2.6) | 0.6 (0.4 to 0.9) |
| V | 132 (55.3%) | 0.68*** (0.59 to 0.76) | 72.6 (60.9 to 82.4) | 64.4 (50.9 to 76.4) | 71.6 (59.9 to 81.5) | 65.5 (51.8 to 77.6) | 2.0 (1.6 to 2.6) | 0.4 (0.3 to 0.7) | |
| FIB-4 | T | 266 (56.8%) | 0.65*** (0.59 to 0.71) | 64.2 (56.0 to 71.9) | 65.2 (55.8 to 73.9) | 70.8 (62.4 to 78.3) | 58.1 (49.1 to 66.8) | 1.9 (1.5 to 2.2) | 0.6 (0.4 to 0.8) |
| V | 132 (55.3%) | 0.70*** (0.61 to 0.78) | 48.0 (36.1 to 60.0) | 86.4 (75.0 to 94.0) | 81.4 (66.4 to 91.7) | 57.3 (46.4 to 67.7) | 3.5 (2.7 to 4.6) | 0.6 (0.3 to 1.2) | |
| Significance fibrosis (≥F2) | |||||||||
| DLRE | 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) | 99.6 (97.4 to 100.0) | 100.0 (99.0 to 100.0) | 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 (95.1 to 99.2) | 37.0 (34.5 to 39.1) | 7.6 (6.8 to 8.2) | 0.3 (0.3 to 0.4) | |
| 2D-SWE | 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) | |
| APRI | T | 266 (83.8%) | 0.54*** (0.47 to 0.60) | 37.7 (31.3 to 44.4) | 74.4 (58.8 to 86.5) | 88.4 (80.2 to 94.1) | 18.7 (13.2 to 25.4) | 1.5 (1.2 to 1.9) | 0.8 (0.5 to 1.4) |
| V | 132 (83.3%) | 0.60*** (0.51 to 0.68) | 62.7 (53.0 to 71.8) | 63.6 (40.7 to 82.8) | 89.6 (80.6 to 95.4) | 25.5 (14.6 to 39.1) | 1.7 (1.2 to 2.4) | 0.6 (0.3 to 1.1) | |
| FIB-4 | T | 266 (83.8%) | 0.56*** (0.49 to 0.62) | 51.1 (44.4 to 57.9) | 62.8 (46.7 to 77.0) | 87.7 (80.8 to 92.8) | 19.9 (13.5 to 27.6) | 1.4 (1.1 to 1.8) | 0.8 (0.5 to 1.2) |
| V | 132 (83.3%) | 0.62** (0.53 to 0.71) | 60.9 (51.1 to 70.1) | 68.2 (45.1 to 86.1) | 90.5 (81.5 to 96.1) | 25.9 (15.2 to 39.2) | 1.9 (1.4 to 2.6) | 0.6 (0.3 to 1.1) | |
Statistical quantifications were demonstrated with 95% CI, when applicable.
AUC of DLRE was statistically compared with AUC of 2D-SWE, APRI and FIB-4, respectively, in the same fibrosis stage (*P<0.05; **P<0.01; ***P<0.001).
2D-SWE, two-dimensional shear wave elastography; APRI, aspartate transaminase-to-platelet ratio index; AUC, area under the receiver operating characteristic curve; DLRE, deep learning Radiomics of elastography; FIB-4, fibrosis index based on four factors; 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.