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Objectives  Accurate classification of focal liver lesions is an important part of liver disease diagnostics. In clinical practice, the lesion type is often determined from the abdominal MR examination, which includes T2-weighted and dynamic contrast enhanced (DCE) MR images. To date, only T2-weighted images are exploited for automatic classification of focal liver lesions. In this study additional MR sequences and risk factors are used for automatic classification to improve the results and to make a step forward to a clinically useful aid for radiologists.    Materials and methods  Clinical MRI data sets of 95 patients with in total 125 benign lesions (40 adenomas, 29 cysts and 56 hemangiomas) and 88 malignant lesions (30 hepatocellular carcinomas (HCC) and 58 metastases) were included in this study. Contrast curve, gray level histogram, and gray level co-occurrence matrix texture features were extracted from the DCE-MR and T2-weighted images. In addition, risk factors including the presence of steatosis, cirrhosis, and a known primary tumor were used as features. Fifty features with the highest ANOVA F-score were selected and fed to an extremely randomized trees classifier. The classifier evaluation was performed using the leave-one-out principle and receiver operating characteristic (ROC) curve analysis.    Results  The overall accuracy for the classification of the five major focal liver lesion types is 0.77. The sensitivity/specificity is 0.80/0.78, 0.93/0.93, 0.84/0.82, 0.73/0.56, and 0.62/0.77 for adenoma, cyst, hemangioma, HCC, and metastasis, respectively.    Conclusion  The proposed classification system using features derived from clinical DCE-MR and T2-weighted images, with additional risk factors is able to differentiate five common types of lesions and is a step forward to a clinically useful aid for focal liver lesion diagnosis.

Automatic classification of focal liver lesions based on MRI and risk factors