Abstract
We developed a multimodal ultrasound (US) deep learning (DL) fusion model to automatically classify early fibrosis in patients with chronic kidney disease (CKD). This prospective study included patients with CKD who underwent continuous gray-scale US, superb microvascular imaging, and strain elastography from May to November 2022. According to the pathological tubular atrophy and interstitial fibrosis score, patients were divided into minimal and mild groups (affected area ≤10% and 11 - 25% of the total cortical volume, respectively). The dataset was divided into training (70%) and test (30%) sets. A DL model combining the features of the three US modes was developed to predict early fibrosis in patients with CKD. We compared these findings with the area under the receiver operating characteristic curve (AUC) of the clinical model by analyzing the receiver operating characteristic curve in the test set. The AUC of single-mode DL based on gray-scale US, superb microvascular imaging, and strain elastography was 0.682, 0.745, and 0.648, respectively, while that of the multimodal US DL model was 0.86. The accuracy, specificity, and sensitivity of the multimodal US DL model were 0.779, 0.767, and 0.796, respectively, and the negative and positive predictive values were 0.842 and 0.706, respectively. The AUC of the multimodal US DL model was significantly better than that of the single-mode DL and clinical models. The DL algorithm developed using multimodal US images can effectively predict early fibrosis in patients with CKD with significantly greater accuracy than single-mode DL or clinical models.