Ultrasound-Based Prediction of Cirrhosis Decompensation Using Large-Scale Computer Vision Models

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 30% of the general population. Ultrasound-based imaging, including B-mode imaging and shear wave elastography (SWE), is widely used for noninvasive fibrosis assessment; however, the role of deep learning-based ultrasound image learning for MASLD risk stratification remains insufficiently characterized. In this study, we developed and evaluated ultrasound image learning pipelines using B-mode and SWE images for fibrosis staging and identification of patients with at-risk metabolic dysfunction-associated steatohepatitis (MASH). A total of 250 ultrasound examinations, one exam per subject, were included. Model performance was evaluated using 3-fold cross-validation with area under the receiver operating characteristic curve (AUROC). End-to-end SWE image learning achieved performance comparable to operator-guided SWE across fibrosis stages. Overall, SWE-based learning consistently outperformed B-mode image learning in fibrosis staging, with AUROC improvements from 0.64 (95%CI: [0.56, 0.72]) to 0.72 (95% CI: [0.65, 0.79]) for F>=2 (significant fibrosis, p=0.11), from 0.67 (95%CI: [0.58, 0.75]) to 0.78 (95% CI:[0.72, 0.85]) for F>=3 (advanced fibrosis, p=0.02), and from 0.69 (95%CI: [0.56, 0.82]) to 0.80 (95%CI: [0.72, 0.89]) for F4 (cirrhosis, p=0.10). These findings highlight the potential of SWE image learning for MASLD risk stratification.

Accurate assessment of Schistosoma japonicum-associated liver fibrosis is essential for disease management and long-term follow-up in endemic regions. Ultrasound provides non-invasive imaging, but complex local echogenic patterns and anatomical structures make fine-grained grading challenging. Existing deep learning methods can predict fibrosis scores, yet directly incorporating acquisition views and regional cues into grading while retaining spatial information for inspection remains an open problem. Here we present VCRE-Fib, a view-conditioned regional evidence framework that integrates anatomical context, local information, and global image assessment for fine-grained ultrasound grading. The framework forms view-conditioned local grading evidence before spatial pooling, uses weak localization to guide its aggregation, and combines it with global predictions. Image-only inference jointly returns a fibrosis score, acquisition view, and candidate abnormal-region map. We developed and evaluated the method on a re-curated cohort of 108,709 ultrasound images from 6,373 patients across 35 centers. On a patient-disjoint test set of 4,107 images from 240 patients across four centers, VCRE-Fib reduced the prespecified composite grading risk by 7.115% relative to SFibAI trained and evaluated on the same data split. Image-level mean absolute error decreased from 0.391 to 0.378, alongside lower patient-max, patient-median, and center-balanced risks. The full model also achieved lower composite grading risk than variants that separately removed view conditioning or weak localization. These results support incorporating anatomical context and regional evidence into ultrasound grading while exposing spatial predictions for inspection alongside severity estimates.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, yet early risk detection is often limited by available diagnostics. Carotid ultrasound, a non-invasive and widely accessible modality, encodes rich structural and hemodynamic information that is largely untapped. Here, we present a machine learning (ML) framework that extracts clinically meaningful representations of vascular damage (VD) from carotid ultrasound videos, using hypertension as a weak proxy label. The model learns robust features that are biologically plausible, interpretable, and strongly associated with established cardiovascular risk factors, comorbidities, and laboratory measures. High VD stratifies individuals for myocardial infarction, cardiac death, and all-cause mortality, matching or outperforming conventional risk models such as SCORE2. Explainable AI analyses reveal that the model relies on vessel morphology and perivascular tissue characteristics, uncovering novel functional and anatomical signatures of vascular damage. This work demonstrates that routine carotid ultrasound contains far more prognostic information than previously recognized. Our approach provides a scalable, non-invasive, and cost-effective tool for population-wide cardiovascular risk assessment, enabling earlier and more personalized prevention strategies without reliance on laboratory tests or complex clinical inputs.