Abstract
Chronic liver disease (CLD) and subsequent liver cirrhosis (LC) are common causes of death and healthcare-related socio-economical costs worldwide. Ultrasound (US) is the first-line imaging modality for assessing the liver and associated hepatocellular carcinomas. Poor quality liver US images caused by aging or inadequate management of US equipment, can pose significant challenges in both diagnosis and treatment. From this perspective, the aim of this study was to enhance and assess the image quality of liver US obtained from an older, lower-performing device using a deep learning approach. A neural network based on a switchable cycle generative adversarial network (CycleGAN) was trained in an unsupervised learning setting, with low-quality images as inputs and high-quality images as targets. The study included consecutively acquired grey-scale liver US examinations from both a 12-year-old and a 4-year-old US device. Images from the older device served as inputs, while images from the newer device were used as targets for the deep learning-based algorithm. Image quality was evaluated by two experienced reviewers. The algorithm significantly improved the brightness, contrast, and overall quality of the reconstructed liver US images (p < 0.001), as assessed by both reviewers. However, no significant differences in image resolution and reverberation artifacts were noted by one of the reviewers. The weighted kappa values for image quality and diagnostic performance ranged from 0.225 to 0.838, indicating fair to almost-perfect inter-reader agreement. The proposed algorithm effectively enhances low-quality liver US images to high diagnostic quality, thereby potentially supporting clinical assessment and intervention in patients with LC.