Background: In steatohepatitis trials, antifibrotic effects are measured by conventional histology, albeit with significant limitations. We assessed how artificial intelligence–assisted, single-fiber quantitative image analysis of hepatic fibrosis matrix measures fibrosis reversal following an intervention that results in major histological improvement. Methods: Fifty-eight patients underwent bariatric surgery with preoperative and follow-up (>1 y) liver biopsies. High-resolution, single-fiber quantitative image analysis extracted quantitative traits of fibrosis, which were combined in a continuous phenotypic fibrosis composite score (Ph-FCS) of fibrosis severity. Changes in Ph-FCS were compared between patients with increasing, decreasing, or stable histological fibrosis stage. Results: The mean follow-up between biopsies was 5.84 years (SD 2.59). Forty patients improved in histological fibrosis stage, 12 were unchanged, and 6 progressed. Median Ph-FCS was reduced from 5.25 at baseline to 3.75 at follow-up ( p <0.001). Baseline Ph-FCS was correlated with Ph-FCS reduction after surgery ( r =0.72, p <0.001). Ph-FCS reduction was higher in patients with a histological ≥1-stage reduction (−1.78, 95% CI: −2.15 to −1.04) than in those unchanged (−1.08, 95% CI: −1.93 to 0.01) or with progression (−0.28, 95% CI: −1.26 to 0.71) ( p <0.02 for differences between groups). The Ph-FCS identified intrastage fibrosis reduction in 9 patients labeled unchanged by conventional histology. Of 34 patients with advanced fibrosis at baseline, 15 still had advanced fibrosis according to histological staging. Despite similar histological staging, their follow-up Ph-FCS was reduced from baseline, although it remained higher than that of the 19 who regressed. Conclusions: Artificial intelligence–assisted, single-fiber image analysis provides an automated measurement of fibrosis changes, which is quantitative and more sensitive to change than conventional pathology and thus can improve the feasibility of antifibrotic trials.
Ratziu et al. (Thu,) studied this question.