title: Quantitative sonographic image analysis for hepatic nodules: a pilot study.
abstract: OBJECTIVE
  The aim of this study was to investigate the feasibility of quantitative image analysis to differentiate hepatic nodules on gray-scale sonographic images.
  
  
  METHODS
  We retrospectively evaluated 35 nodules from 31 patients with hepatocellular carcinoma (HCC), 60 nodules from 58 patients with liver hemangioma, and 22 nodules from 22 patients with liver metastasis. Gray-scale sonographic images were evaluated with subjective judgment and image analysis using ImageJ software. Reviewers classified the shape of nodules as irregular or round, and the surface of nodules as rough or smooth.
  
  
  RESULTS
  Circularity values were lower in the irregular group than in the round group (median 0.823, 0.892; range 0.641-0.915, 0.784-0.932, respectively; P = 3.21 × 10(-10)). Solidity values were lower in the rough group than in the smooth group (median 0.957, 0.968; range 0.894-0.986, 0.933-0.988, respectively; P = 1.53 × 10(-4)). The HCC group had higher circularity and solidity values than the hemangioma group. The HCC and liver metastasis groups had lower median, mean, modal, and minimum gray values than the hemangioma group. Multivariate analysis showed circularity [standardized odds ratio (OR), 2.077; 95 % confidential interval (CI) = 1.295-3.331; P = 0.002] and minimum gray value (OR 0.482; 95 % CI = 0.956-0.990; P = 0.001) as factors predictive of malignancy. The combination of subjective judgment and image analysis provided 58.3 % sensitivity and 89.5 % specificity with AUC = 0.739, representing an improvement over subjective judgment alone (68.4 % sensitivity, 75.0 % specificity, AUC = 0.701) (P = 0.008).
  
  
  CONCLUSIONS
  Quantitative image analysis for ultrasonic images of hepatic nodules may correlate with subjective judgment in predicting malignancy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan. matsumotosg7@gmail.com.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumoto
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Takayasu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Hirayama
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Miura
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Shiozawa
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Abe
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawara
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Moriyama
authors.affiliation: Department of Mathematics, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi, Tokyo, 173-8610, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Udagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: Hepatocellular carcinoma; Liver hemangioma; Liver metastasis; Quantitative image analysis; Ultrasonography