European Radiology

, Volume 29, Issue 5, pp 2175–2184 | Cite as

Quantitative ultrasound and machine learning for assessment of steatohepatitis in a rat model

  • An TangEmail author
  • François Destrempes
  • Siavash Kazemirad
  • Julian Garcia-Duitama
  • Bich N. Nguyen
  • Guy Cloutier



To develop a machine learning model based on quantitative ultrasound (QUS) parameters to improve classification of steatohepatitis with shear wave elastography in rats by using histopathology scoring as the reference standard.


This study received approval from the institutional animal care committee. Sixty male Sprague-Dawley rats were either fed a standard chow or a methionine- and choline-deficient diet. Ultrasound-based radiofrequency images were recorded in vivo to generate QUS and elastography maps. Random forests classification models and a bootstrap method were used to identify the QUS parameters that improved the classification accuracy of elastography. Receiver-operating characteristic analyses were performed.


For classification of not steatohepatitis vs borderline or steatohepatitis, the area under the receiver-operating characteristic curve (AUC) increased from 0.63 for elastography alone to 0.72 for a model that combined elastography and QUS techniques (p < 0.001). For detection of liver steatosis grades 0 vs ≥ 1, ≤ 1 vs ≥ 2, ≤ 2 vs 3, respectively, the AUCs increased from 0.70, 0.65, and 0.69 to 0.78, 0.78, and 0.75 (p < 0.001). For detection of liver inflammation grades 0 vs ≥ 1, ≤ 1 vs ≥ 2, ≤ 2 vs 3, respectively, the AUCs increased from 0.58, 0.77, and 0.78 to 0.66, 0.84, and 0.87 (p < 0.001). For staging of liver fibrosis grades 0 vs ≥ 1, ≤ 1 vs ≥ 2, and ≤ 2 vs ≥ 3, respectively, the AUCs increased from 0.79, 0.92, and 0.91 to 0.85, 0.98, and 0.97 (p < 0.001).


QUS parameters improved the classification accuracy of steatohepatitis, liver steatosis, inflammation, and fibrosis compared to shear wave elastography alone.

Key Points

• Quantitative ultrasound and shear wave elastography improved classification accuracy of liver steatohepatitis and its histological features (liver steatosis, inflammation, and fibrosis) compared to elastography alone.

• A machine learning approach based on random forest models and incorporating local attenuation and homodyned-K tissue modeling shows promise for classification of nonalcoholic steatohepatitis.

• Further research should be performed to demonstrate the applicability of this multi-parametric QUS approach in a human cohort and to validate the combinations of parameters providing the highest classification accuracy.


Nonalcoholic steatohepatitis Non-alcoholic fatty liver disease Machine learning Ultrasonography Elasticity imaging techniques 



Area under the receiver-operating characteristic curve


Controlled attenuation parameter


Homodyned-K distributions


Hematoxylin phloxine saffron


Inter-quartile range


Methionine and choline deficient


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Quantitative ultrasound


Receiver operating characteristic


Region of interest





We thank Mr. Jamal Ait Ichou for his assistance in the literature review.


This study has received funding by Fonds de Recherche du Québec—Nature et Technologies (FRQNT) (PR-174387), Canadian Institutes of Health Research, Institute of Nutrition, Metabolism, and Diabetes (grant nos. 273738 and 301520), Quebec Bio-imaging Network (QBIN/RBIQ #5886), New Researcher Startup Grant from the Centre de Recherche du Centre Hospitalier de l’Université de Montréal, and by a Chercheur-Boursier Junior 2 from the Fonds de Recherche du Québec en Santé and Fondation de l’association des radiologistes du Québec (FRQS-ARQ #34939) to An Tang.

Compliance with ethical standards


The scientific guarantor if this publication is An Tang.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Approval from the institutional animal care committee was obtained.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

The study cohorts have been previously reported in [24]. That prior article focused on a comparison between low-frequency versus high-frequency ultrasonographic shear wave elastography for the detection of steatohepatitis. In contrast, the present article investigates a machine learning model based on quantitative ultrasound parameters to improve classification of steatohepatitis compared to shear wave elastography alone.


• Diagnostic study

• Experimental

• Performed at one institution

Supplementary material

330_2018_5915_MOESM1_ESM.docx (45 kb)
ESM 1 (DOCX 44 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyCentre hospitalier de l’Université de Montréal (CHUM)QuébecCanada
  2. 2.Department of Radiology, Radio-oncology and Nuclear MedicineUniversité de Montréal and CRCHUMQuébecCanada
  3. 3.Laboratory of Medical Image AnalysisCentre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)QuébecCanada
  4. 4.Université de MontréalInstitute of Biomedical EngineeringQuébecCanada
  5. 5.Laboratory of Biorheology and Medical Ultrasonics (LBUM)Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)QuébecCanada
  6. 6.School of Mechanical EngineeringIran University of Science and TechnologyTehranIran
  7. 7.Department of PathologyCentre hospitalier de l’Université de Montréal (CHUM)QuébecCanada
  8. 8.Department of Pathology and Cellular BiologyUniversité de MontréalQuébecCanada

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