Deep-learning-based washout classification for decision support in contrast-enhanced ultrasound examinations of the liver.

Purpose: Contrast-enhanced ultrasound (CEUS) is a reliable tool to diagnose focal liver lesions, which appear ambiguous in normal B-mode ultrasound. However, interpretation of the dynamic contrast sequences can be challenging, hindering the widespread application of CEUS. We investigate the use of a deep-learning-based image classifier for determining the diagnosis-relevant feature washout from CEUS acquisitions. Approach: We introduce a data representation, which is agnostic to data heterogeneity regarding lesion size, subtype, and length of the sequences. Then, an image-based classifier is exploited for washout classification. Strategies to cope with sparse annotations and motion are systematically evaluated, as well as the potential benefits of using a perfusion model to cover missing time points. Results: Results indicate decent performance comparable to studies found in the literature, with a maximum balanced accuracy of 84.0% on the validation and 82.0% on the test set. Correlation-based frame selection yielded improvements in classification performance, whereas further motion compensation did not show any benefit in the conducted experiments. Conclusions: It is shown that deep-learning-based washout classification is feasible in principle. It offers a simple form of interpretability compared with benign versus malignant classifications. The concept of classifying individual features instead of the diagnosis itself could be extended to other features such as the arterial inflow behavior. The main factors distinguishing it from existing approaches are the data representation and task formulation, as well as a large dataset size with 500 liver lesions from two centers for algorithmic development and testing.