Opportunistic Screening of Chronic Liver Disease with Deep Learning Enhanced Echocardiography

ABSTRACT Importance Chronic liver disease affects more than 1.5 billion adults worldwide, however the majority of cases are asymptomatic and undiagnosed. Echocardiography is broadly performed and visualizes the liver; but this information is not leveraged. Objective To develop and evaluate a deep learning algorithm on echocardiography videos to enable opportunistic screening for chronic liver disease. Design Retrospective observational cohorts Setting Two large urban academic medical centers Participants Adult patients who received echocardiography and abdominal imaging (either abdominal ultrasound or abdominal magnetic resonance imaging) with ≤30 days between tests, between July 4, 2012, to June 4, 2022. Exposure Deep learning model predictions from a deep-learning computer vision pipeline that identifies subcostal view echocardiogram videos and detects the presence of cirrhosis or steatotic liver disease (SLD). Main Outcome and Measures Clinical diagnosis by paired abdominal ultrasound or magnetic resonance imaging (MRI). Results A total of 1,596,640 echocardiogram videos (66,922 studies from 24,276 patients) from Cedars-Sinai Medical Center (CSMC) were used to develop EchoNet-Liver, an automated pipeline that identifies high quality subcostal images from echocardiogram studies and detects the presence of cirrhosis or SLD. In the held-out CSMC test cohort, EchoNet-Liver was able to detect the presence of cirrhosis with an AUC of 0.837 (0.789 - 0.880) and SLD with an AUC of 0.799 (0.758 - 0.837). In a separate test cohort with paired abdominal MRIs, cirrhosis was detected with an AUC of 0.704 (0.689-0.718) and SLD was detected with an AUC of 0.726 (0.659-0.790). In an external test cohort of 106 patients (n = 5,280 videos), the model detected cirrhosis with an AUC of 0.830 (0.738 - 0.909) and SLD with an AUC of 0.768 (0.652 – 0.875). Conclusions and Relevance Deep learning assessment of clinical echocardiography enables opportunistic screening of SLD and cirrhosis. Application of this algorithm may identify patients who may benefit from further diagnostic testing and treatment for chronic liver disease. KEY POINTS Question Can a deep learning algorithm applied to echocardiography videos effectively identify chronic liver diseases including cirrhosis and steatotic liver disease (SLD)? Findings This retrospective observational cohort study utilized 1,596,640 echocardiography videos from 66,922 studies of 24,276 patients. The deep learning model with a computer vision pipeline (EchoNet-Liver) demonstrated strong performance to detect cirrhosis and SLD. External validation at a geographically distinct site demonstrated similar discriminative ability. Meaning The application of EchoNet-Liver to echocardiography could aid opportunistic screening of chronic liver diseases, providing a unique cost-effective angle to improve patient management.