Optimal Elasticity cut-off value for discriminating Healthy to Pathological Fibrotic patients employing Fuzzy C-Means automatic segmentation in Liver Shear Wave Elastography images

The aim of the present study is to determine an optimal elasticity cut-off value for discriminating Healthy from Pathological fibrotic patients by means of Fuzzy C-Means automatic segmentation and maximum participation cluster mean value employment in Shear Wave Elastography (SWE) images. The clinical dataset comprised 32 subjects (16 Healthy and 16 histological or Fibroscan verified Chronic Liver Disease). An experienced Radiologist performed SWE measurement placing a region of interest (ROI) on each subject's right liver lobe providing a SWE image for each patient. Subsequently Fuzzy C-Means clustering was performed on every SWE image utilizing 5 clusters. Mean Stiffness value and pixels number of each cluster were calculated. The mean stiffness value feature of the cluster with maximum pixels number was then fed as input for ROC analysis. The selected Mean Stiffness value feature an Area Under the Curve (AUC) of 0.8633 with Optimum Cut-off value of 7.5 kPa with sensitivity and specificity values of 0.8438 and 0.875 and balanced accuracy of 0.8594. Examiner's classification measurements exhibited sensitivity, specificity and balanced accuracy value of 0.8125 with 7.1 kPa cutoff value. A new promising automatic algorithm was implemented with more objective criteria of defining optimum elasticity cut-off values for discriminating fibrosis stages for SWE. More subjects are needed in order to define if this algorithm is an objective tool to outperform manual ROI selection.