Noninvasive Assessment of Liver Fibrosis and Inflammation in Chronic Hepatitis B:A Dual-task Convolutional Neural Network(DtCNN)Model Based on Ultrasound Shear Wave Elastography

Background and Aims:Liver stiffness(LS)measured by shear wave elastography(SWE)is often influenced by hepat-ic inflammation.The aim was to develop a dual-task convo-lutional neural network(DtCNN)model for the simultaneous staging of liver fibrosis and inflammation activity using 2D-SWE.Methods:A total of 532 patients with chronic hepatitis B(CHB)were included to develop and validate the DtCNN model.An additional 180 consecutive patients between De-cember 2019 and April 2021 were prospectively included for further validation.All patients underwent 2D-SWE examina-tion and serum biomarker assessment.A DtCNN model con-taining two pathways for the staging of fibrosis and inflam-mation was used to improve the classification of significant fibrosis(≥F2),advanced fibrosis(≥F3)as well as cirrhosis(F4).Results:Both fibrosis and inflammation affected LS measurements by 2D-SWE.The proposed DtCNN performed the best among all the classification models for fibrosis stage[significant fibrosis AUC=0.89(95%CI:0.87-0.92),ad-vanced fibrosis AUC=0.87(95%CI:0.84-0.90),liver cirrho-sis AUC=0.85(95%CI:0.81-0.89)].The DtCNN-based pre-diction of inflammation activity achieved AUCs of 0.82(95%CI:0.78-0.86)for grade≥A1,0.88(95%CI:0.85-0.90)grade≥A2 and 0.78(95%CI:0.75-0.81)for grade≥A3,which were significantly higher than the AUCs of the single-task groups.Similar findings were observed in the prospec-tive study.Conclusions:The proposed DtCNN improved di-agnostic performance compared with existing fibrosis staging models by including inflammation in the model,which sup-ports its potential clinical application.

Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal:A nationwide,multicenter study

Background:Carotid intima-media thickness(IMT)and diameter,stiffness,and wave reflections,are independent and important clinical biomarkers and risk predictors for cardiovascular diseases.The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods:A total of 3053 healthy Han Chinese adults(1922 women)aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022.The real-time tracking of common carotid artery walls was achieved by the radio frequency(RF)ultrasound system.The IMT,diameter,compliance coefficient,βstiffness,local pulse wave velocity(PWV),local systolic blood pressure,augmented pressure(AP),and augmentation index(AIx)were then automatically measured and reported.Data were stratified by age groups and sex.The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions.The major clinical determinants of carotid properties were identified by Pearson’s correlation,multiple linear regression,and analyses of covariance.Results:All the parameters of carotid properties demonstrated significantly age-related trajectories.Women showed thinner IMT,smaller carotid diameter,larger AP,and AIx than men.Theβstiffness and PWV were significantly higher in men than women before forties,but the differences reversed after that.The increase rate of carotid IMT(5.5µm/year in women and 5.8µm/year in men)and diameter(0.03 mm/year in both men and women)were similar between men and women.For the stiffness and wave reflections,women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes(all P for age by sex interaction<0.05).The blood pressures,body mass index(BMI),and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.Conclusions:The age-and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established.The blood pressures,BMI,and triglyceride levels should be considered for clinical application of corresponding reference values.