Artificial intelligence assists operators in real-time detection of focal liver lesions during ultrasound: A randomized controlled study.

PURPOSE: Detection of hepatocellular carcinoma (HCC) is crucial during surveillance by ultrasound. We previously developed an artificial intelligence (AI) system based on convolutional neural network for detection of focal liver lesions (FLLs) in ultrasound. The primary aim of this study was to evaluate whether the AI system can assist non-expert operators to detect FLLs in real-time, during ultrasound examinations. METHOD: This single-center prospective randomized controlled study evaluated the AI system in assisting non-expert and expert operators. Patients with and without FLLs were enrolled and had ultrasound performed twice, with and without AI assistance. McNemar's test was used to compare paired FLL detection rates and false positives between groups with and without AI assistance. RESULTS: 260 patients with 271 FLLs and 244 patients with 240 FLLs were enrolled into the groups of non-expert and expert operators, respectively. In non-experts, FLL detection rate in the AI assistance group was significantly higher than the no AI assistance group (36.9 % vs 21.4 %, p < 0.001). In experts, FLL detection rates were not significantly different between the groups with and without AI assistance (66.7 % vs 63.3 %, p = 0.32). False positive detection rates in the groups with and without AI assistance were not significantly different in both non-experts (14.2 % vs 9.2 %, p = 0.08) and experts (8.6 % vs 9.0 %, p = 0.85). CONCLUSIONS: The AI system resulted in significant increase in detection of FLLs during ultrasound examinations by non-experts. Our findings may support future use of the AI system in resource-limited settings where ultrasound examinations are performed by non-experts. The study protocol was registered under the Thai Clinical Trial Registry (TCTR20201230003), which is part of the WHO ICTRP Registry Network. The registry can be accessed via the following URL: https://trialsearch.who.int/Trial2.aspx?TrialID=TCTR20201230003.

The feasibility to use artificial intelligence to aid detecting focal liver lesions in real-time ultrasound: a preliminary study based on videos.

Despite the wide availability of ultrasound machines for hepatocellular carcinoma surveillance, an inadequate number of expert radiologists performing ultrasounds in remote areas remains a primary barrier for surveillance. We demonstrated feasibility of artificial intelligence (AI) to aid in the detection of focal liver lesions (FLLs) during ultrasound. An AI system for FLL detection in ultrasound videos was developed. Data in this study were prospectively collected at a university hospital. We applied a two-step training strategy for developing the AI system by using a large collection of ultrasound snapshot images and frames from full-length ultrasound videos. Detection performance of the AI system was evaluated and then compared to detection performance by 25 physicians including 16 non-radiologist physicians and 9 radiologists. Our dataset contained 446 videos (273 videos with 387 FLLs and 173 videos without FLLs) from 334 patients. The videos yielded 172,035 frames with FLLs and 1,427,595 frames without FLLs for training on the AI system. The AI system achieved an overall detection rate of 89.8% (95%CI: 84.5-95.0) which was significantly higher than that achieved by non-radiologist physicians (29.1%, 95%CI: 21.2-37.0, p < 0.001) and radiologists (70.9%, 95%CI: 63.0-78.8, p < 0.001). Median false positive detection rate by the AI system was 0.7% (IQR: 1.3%). AI system operation speed reached 30-34 frames per second, showing real-time feasibility. A further study to demonstrate whether the AI system can assist operators during ultrasound examinations is warranted.