Multimodal imaging and artificial intelligence empowering the diagnosis and treatment of autoimmune liver diseases: research status and prospects_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Danfeng ¹ , HE Liyi ² ,  ZHANG Yun ²

1. State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

ZHANG Yun, Email: drzhangy91@163.com

Keywords：

autoimmune liver disease; imaging diagnosis; multimodal imaging; artificial intelligence

DOI：

10.7507/1007-9424.202509132

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the application of multimodal imaging techniques in autoimmune liver diseases (AILDs), focusing on disease diagnosis and the non-invasive assessment of inflammatory activity and liver fibrosis, and to define the value of non-invasive radiology and artificial intelligence (AI). The limitations and future directions of current research are also discussed. Methods Relevant studies concerning multimodal imaging [ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI)/functional MRI] and AI in AILDs management were retrieved and reviewed. Results Multimodal imaging technologies provide critical evidence for clinical diagnosis and assessment of AILDs due to their non-invasive and dynamic advantages. Functional MRI enables precise quantification of liver fibrosis, inflammatory activity, and bile duct structural alterations, facilitating objective evaluation of disease progression. AI, with its powerful data mining and pattern recognition capabilities, offers new pathways to address challenges like subjectivity and lack of individualization in AILDs management. However, most studies are single-center with small samples, multimodal data integration remains insufficient, and the sensitivity of non-invasive imaging for early AILDs diagnosis is still limited. Conclusions Multimodal imaging and AI can effectively address the limitations of traditional diagnostic methods, advancing the precision of AILDs diagnosis and treatment. Future efforts should focus on developing integrated analytical models that combine multidimensional data including imaging, clinical, and pathological information, to overcome early diagnosis bottlenecks and enhance the accuracy and practicality of treatment efficacy assessment and prognosis prediction.

Citation： CHEN Danfeng, HE Liyi, ZHANG Yun. Multimodal imaging and artificial intelligence empowering the diagnosis and treatment of autoimmune liver diseases: research status and prospects. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(1): 63-69. doi: 10.7507/1007-9424.202509132 Copy

1.	Zhang Y, Hu X, Chang J, et al. Ultrasound imaging findings in primary biliary cholangitis. BMC Gastroenterol, 2023, 23(1): 448. doi: 10.1186/s12876-023-03083-w.
2.	Idilman IS, Venkatesh SH, Eaton JE, et al. Magnetic resonance imaging features in 283 patients with primary biliary cholangitis. Eur Radiol, 2020, 30(9): 5139-5148.
3.	Zhang Y, Huang C, Meng F, et al. Non-invasive assessment of esophageal and fundic varices in patients with primary biliary cholangitis. Eur Radiol, 2025, 35(4): 2330-2338.
4.	Zhang Y, Zheng T, Huang Z, et al. CT and MR imaging of primary biliary cholangitis: a pictorial review. Insights Imaging, 2023, 14(1): 180. doi: 10.1186/s13244-023-01517-3.
5.	趙宏偉, 祝佳, 張國良, 等. 原發性膽汁性膽管炎患者磁共振檢查肝臟表現特點分析. 肝臟, 2021, 26(8): 903-906.
6.	夏亮芳. 原發性硬化性膽管炎 (附24例報告). 中國普外基礎與臨床雜志, 2001, 8(2): 81-82, 100.
7.	Morgan MA, Khot R, Sundaram KM, et al. Primary sclerosing cholangitis: review for radiologists. Abdom Radiol (NY), 2023, 48(1): 136-150.
8.	于建安, 賈翠宇, 武志崗, 等. 原發性硬化性膽管炎的臨床和影像學特征分析. 北京醫學, 2022, 44(10): 897-901, 906.
9.	劉彥榮, 王苗, 曾果, 等. MRI彌散加權成像對原發性硬化性膽管炎患者肝纖維化評估價值分析. 實用肝臟病雜志, 2021, 24(3): 375-378.
10.	陳曦, 李志艷, 車轔, 等. 自身免疫性肝炎患者的超聲表現與病理及實驗室檢查的相關性分析. 中華醫學超聲雜志 (電子版), 2018, 15(4): 263-267.
11.	單亞林, 王秋陽. 超聲瞬時彈性成像結合全身免疫炎癥指數預測自身免疫性肝炎發生肝硬化的價值. 肝臟, 2024, 29(11): 1334-1337.
12.	韓笑, 馬紅. 自身免疫性肝炎的影像學研究進展. 肝臟, 2024, 29(3): 363-366.
13.	Gomes NBN, Torres US, Ferraz MLCG, et al. Autoimmune hepatitis in practice, from diagnosis to complications: what is the role of imaging? A clinicoradiological review. Clin Imaging, 2021, 74: 31-40.
14.	尹全樂, 陳旭, 王穎. 自身免疫性肝病的影像學診治現狀. 醫學信息, 2020, 33(14): 40-43.
15.	瞿獻莉, 袁梅, 高紅, 等. MRI在自身免疫性肝炎診治中的應用價值. 影像研究與醫學應用, 2022, 6(6): 172-174.
16.	孟占鰲, 彭令榮, 張可. 自身免疫性肝炎核磁共振成像的臨床價值. 中國醫學物理學雜志, 2017, 34(8): 816-819.
17.	Abu Ata N, Dillman JR, Gandhi DB, et al. Association between liver diffusion-weighted imaging apparent diffusion coefficient values and other measures of liver disease in pediatric autoimmune liver disease patients. Abdom Radiol (NY), 2021, 46(1): 197-204.
18.	Keller S, Sedlacik J, Schuler T, et al. Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis. Eur Radiol, 2019, 29(2): 818-828.
19.	Zheng Y, Xu YS, Liu Z, et al. Whole-liver apparent diffusion coefficient histogram analysis for the diagnosis and staging of liver fibrosis. J Magn Reson Imaging, 2020, 51(6): 1745-1754.
20.	陳雅樂. 自身免疫性肝病的磁共振多模態成像研究. 河南: 鄭州大學, 2022.
21.	黃夢月, 陳雅樂, 黃夢娜, 等. 增強MRI對自身免疫性肝病肝小葉結構的研究. 中國CT和MRI雜志, 2024, 22(11): 95-97.
22.	McCrary J, Trout AT, Mahalingam N, et al. Associations between quantitative MRI metrics and clinical risk scores in children and young adults with autoimmune liver disease. AJR Am J Roentgenol, 2022, 219(1): 142-150.
23.	Mesropyan N, Kupczyk P, Dold L, et al. Non-invasive assessment of liver fibrosis in autoimmune hepatitis: diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction. Abdom Radiol (NY), 2021, 46(6): 2458-2466.
24.	Dillman JR, Tkach JA, Gandhi D, et al. Relationship between magnetic resonance imaging spleen T1 relaxation and other radiologic and clinical biomarkers of liver fibrosis in children and young adults with autoimmune liver disease. Abdom Radiol (NY), 2020, 45(11): 3709-3715.
25.	韓丹, 張潔, 靳二虎, 等. 釓塞酸二鈉增強MRI評價原發性膽汁性膽管炎患者肝功能的可行性研究. 磁共振成像, 2017, 8(5): 337-342.
26.	Elkilany A, Geisel D, Müller T, et al. Gadoxetic acid-enhanced MRI in primary sclerosing cholangitis: added value in assessing liver function and monitoring disease progression. Abdom Radiol (NY), 2021, 46(3): 979-991.
27.	Poetter-Lang S, Ba-Ssalamah A, Messner A, et al. Disease severity prognostication in primary sclerosing cholangitis: a validation of the Anali scores and comparison with the potential functional stricture. Eur Radiol, 2024, 34(12): 7632-7644.
28.	Liu C, Sun Y, Yang Y, et al. Gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase can predict progression in patients with liver cirrhosis. Eur Radiol, 2021, 31(8): 5840-5850.
29.	You H, Ma X, Efe C, et al. APASL clinical practice guidance: the diagnosis and management of patients with primary biliary cholangitis. Hepatol Int, 2022, 16(1): 1-23.
30.	Natarajan Y, Tansel A, Patel P, et al. Incidence of hepatocellular carcinoma in primary biliary cholangitis: a systematic review and meta-analysis. Dig Dis Sci, 2021, 66(7): 2439-2451.
31.	Chernyak V, Fowler KJ, Kamaya A, et al. Liver imaging reporting and data system (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology, 2018, 289(3): 816-830.
32.	Bastati N, Beer L, Mandorfer M, et al. Does the functional liver imaging score derived from gadoxetic acid-enhanced MRI predict outcomes in chronic liver disease?. Radiology, 2020, 294(1): 98-107.
33.	Zerunian M, Masci B, Caruso D, et al. Liver magnetic resonance elastography: focus on methodology, technique, and feasibility. Diagnostics (Basel), 2024, 14(4): 379. doi: 10.3390/diagnostics14040379.
34.	Dillman JR, Trout AT, Taylor AE, et al. Association between MR elastography liver stiffness and histologic liver fibrosis in children and young adults with autoimmune liver disease. AJR Am J Roentgenol, 2024, 223(1): e2431108. doi: 10.2214/AJR.24.31108.
35.	Lefebvre T, Wartelle-Bladou C, Wong P, et al. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol, 2019, 29(12): 6477-6488.
36.	Osman KT, Maselli DB, Idilman IS, et al. Liver stiffness measured by either magnetic resonance or transient elastography is associated with liver fibrosis and is an independent predictor of outcomes among patients with primary biliary cholangitis. J Clin Gastroenterol, 2021, 55(5): 449-457.
37.	蔣卓儒, 張海龍, 朱正陽, 等. 磁共振彈性成像在慢性肝臟疾病中的應用進展. 磁共振成像, 2025, 16(3): 190-195.
38.	Poetter-Lang S, Messner A, Bastati N, et al. Diagnosis of functional strictures in patients with primary sclerosing cholangitis using hepatobiliary contrast-enhanced MRI: a proof-of-concept study. Eur Radiol, 2023, 33(12): 9022-9037.
39.	Ringe KI, Vo Chieu VD, Wacker F, et al. Fully automated detection of primary sclerosing cholangitis (PSC)-compatible bile duct changes based on 3D magnetic resonance cholangio- pancreatography using machine learning. Eur Radiol, 2021, 31(4): 2482-2489.
40.	Cristoferi L, Porta M, Bernasconi DP, et al. A quantitative MRCP-derived score for medium-term outcome prediction in primary sclerosing cholangitis. Dig Liver Dis, 2023, 55(3): 373-380.
41.	Cazzagon N, El Mouhadi S, Vanderbecq Q, et al. Quantitative magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in people with primary sclerosing cholangitis. JHEP Rep, 2022, 4(11): 100577. doi: 10.1016/j.jhepr.2022.100577.
42.	Selvaraj EA, Ba-Ssalamah A, Poetter-Lang S, et al. A quantitative magnetic resonance cholangiopancreatography metric of intrahepatic biliary dilatation severity detects high-risk primary sclerosing cholangitis. Hepatol Commun, 2022, 6(4): 795-808.
43.	Grigoriadis A, Ringe KI, Andersson M, et al. Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis. Eur J Radiol, 2021, 142: 109884. doi: 10.1016/j.ejrad.2021.109884.
44.	Eaton JE, Vesterhus M, McCauley BM, et al. Primary sclerosing cholangitis risk estimate tool (PREsTo) predicts outcomes of the disease: a derivation and validation study using machine learning. Hepatology, 2020, 71(1): 214-224.
45.	Engel B, Assis DN, Bhat M, et al. Quo vadis autoimmune hepatitis? - summary of the 5th international autoimmune hepatitis group research workshop 2024. JHEP Rep, 2024, 7(2): 101265. doi: 10.1016/j.jhepr.2024.101265.

1. Zhang Y, Hu X, Chang J, et al. Ultrasound imaging findings in primary biliary cholangitis. BMC Gastroenterol, 2023, 23(1): 448. doi: 10.1186/s12876-023-03083-w.
2. Idilman IS, Venkatesh SH, Eaton JE, et al. Magnetic resonance imaging features in 283 patients with primary biliary cholangitis. Eur Radiol, 2020, 30(9): 5139-5148.
3. Zhang Y, Huang C, Meng F, et al. Non-invasive assessment of esophageal and fundic varices in patients with primary biliary cholangitis. Eur Radiol, 2025, 35(4): 2330-2338.
4. Zhang Y, Zheng T, Huang Z, et al. CT and MR imaging of primary biliary cholangitis: a pictorial review. Insights Imaging, 2023, 14(1): 180. doi: 10.1186/s13244-023-01517-3.
5. 趙宏偉, 祝佳, 張國良, 等. 原發性膽汁性膽管炎患者磁共振檢查肝臟表現特點分析. 肝臟, 2021, 26(8): 903-906.
6. 夏亮芳. 原發性硬化性膽管炎 (附24例報告). 中國普外基礎與臨床雜志, 2001, 8(2): 81-82, 100.
7. Morgan MA, Khot R, Sundaram KM, et al. Primary sclerosing cholangitis: review for radiologists. Abdom Radiol (NY), 2023, 48(1): 136-150.
8. 于建安, 賈翠宇, 武志崗, 等. 原發性硬化性膽管炎的臨床和影像學特征分析. 北京醫學, 2022, 44(10): 897-901, 906.
9. 劉彥榮, 王苗, 曾果, 等. MRI彌散加權成像對原發性硬化性膽管炎患者肝纖維化評估價值分析. 實用肝臟病雜志, 2021, 24(3): 375-378.
10. 陳曦, 李志艷, 車轔, 等. 自身免疫性肝炎患者的超聲表現與病理及實驗室檢查的相關性分析. 中華醫學超聲雜志 (電子版), 2018, 15(4): 263-267.
11. 單亞林, 王秋陽. 超聲瞬時彈性成像結合全身免疫炎癥指數預測自身免疫性肝炎發生肝硬化的價值. 肝臟, 2024, 29(11): 1334-1337.
12. 韓笑, 馬紅. 自身免疫性肝炎的影像學研究進展. 肝臟, 2024, 29(3): 363-366.
13. Gomes NBN, Torres US, Ferraz MLCG, et al. Autoimmune hepatitis in practice, from diagnosis to complications: what is the role of imaging? A clinicoradiological review. Clin Imaging, 2021, 74: 31-40.
14. 尹全樂, 陳旭, 王穎. 自身免疫性肝病的影像學診治現狀. 醫學信息, 2020, 33(14): 40-43.
15. 瞿獻莉, 袁梅, 高紅, 等. MRI在自身免疫性肝炎診治中的應用價值. 影像研究與醫學應用, 2022, 6(6): 172-174.
16. 孟占鰲, 彭令榮, 張可. 自身免疫性肝炎核磁共振成像的臨床價值. 中國醫學物理學雜志, 2017, 34(8): 816-819.
17. Abu Ata N, Dillman JR, Gandhi DB, et al. Association between liver diffusion-weighted imaging apparent diffusion coefficient values and other measures of liver disease in pediatric autoimmune liver disease patients. Abdom Radiol (NY), 2021, 46(1): 197-204.
18. Keller S, Sedlacik J, Schuler T, et al. Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis. Eur Radiol, 2019, 29(2): 818-828.
19. Zheng Y, Xu YS, Liu Z, et al. Whole-liver apparent diffusion coefficient histogram analysis for the diagnosis and staging of liver fibrosis. J Magn Reson Imaging, 2020, 51(6): 1745-1754.
20. 陳雅樂. 自身免疫性肝病的磁共振多模態成像研究. 河南: 鄭州大學, 2022.
21. 黃夢月, 陳雅樂, 黃夢娜, 等. 增強MRI對自身免疫性肝病肝小葉結構的研究. 中國CT和MRI雜志, 2024, 22(11): 95-97.
22. McCrary J, Trout AT, Mahalingam N, et al. Associations between quantitative MRI metrics and clinical risk scores in children and young adults with autoimmune liver disease. AJR Am J Roentgenol, 2022, 219(1): 142-150.
23. Mesropyan N, Kupczyk P, Dold L, et al. Non-invasive assessment of liver fibrosis in autoimmune hepatitis: diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction. Abdom Radiol (NY), 2021, 46(6): 2458-2466.
24. Dillman JR, Tkach JA, Gandhi D, et al. Relationship between magnetic resonance imaging spleen T1 relaxation and other radiologic and clinical biomarkers of liver fibrosis in children and young adults with autoimmune liver disease. Abdom Radiol (NY), 2020, 45(11): 3709-3715.
25. 韓丹, 張潔, 靳二虎, 等. 釓塞酸二鈉增強MRI評價原發性膽汁性膽管炎患者肝功能的可行性研究. 磁共振成像, 2017, 8(5): 337-342.
26. Elkilany A, Geisel D, Müller T, et al. Gadoxetic acid-enhanced MRI in primary sclerosing cholangitis: added value in assessing liver function and monitoring disease progression. Abdom Radiol (NY), 2021, 46(3): 979-991.
27. Poetter-Lang S, Ba-Ssalamah A, Messner A, et al. Disease severity prognostication in primary sclerosing cholangitis: a validation of the Anali scores and comparison with the potential functional stricture. Eur Radiol, 2024, 34(12): 7632-7644.
28. Liu C, Sun Y, Yang Y, et al. Gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase can predict progression in patients with liver cirrhosis. Eur Radiol, 2021, 31(8): 5840-5850.
29. You H, Ma X, Efe C, et al. APASL clinical practice guidance: the diagnosis and management of patients with primary biliary cholangitis. Hepatol Int, 2022, 16(1): 1-23.
30. Natarajan Y, Tansel A, Patel P, et al. Incidence of hepatocellular carcinoma in primary biliary cholangitis: a systematic review and meta-analysis. Dig Dis Sci, 2021, 66(7): 2439-2451.
31. Chernyak V, Fowler KJ, Kamaya A, et al. Liver imaging reporting and data system (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology, 2018, 289(3): 816-830.
32. Bastati N, Beer L, Mandorfer M, et al. Does the functional liver imaging score derived from gadoxetic acid-enhanced MRI predict outcomes in chronic liver disease?. Radiology, 2020, 294(1): 98-107.
33. Zerunian M, Masci B, Caruso D, et al. Liver magnetic resonance elastography: focus on methodology, technique, and feasibility. Diagnostics (Basel), 2024, 14(4): 379. doi: 10.3390/diagnostics14040379.
34. Dillman JR, Trout AT, Taylor AE, et al. Association between MR elastography liver stiffness and histologic liver fibrosis in children and young adults with autoimmune liver disease. AJR Am J Roentgenol, 2024, 223(1): e2431108. doi: 10.2214/AJR.24.31108.
35. Lefebvre T, Wartelle-Bladou C, Wong P, et al. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol, 2019, 29(12): 6477-6488.
36. Osman KT, Maselli DB, Idilman IS, et al. Liver stiffness measured by either magnetic resonance or transient elastography is associated with liver fibrosis and is an independent predictor of outcomes among patients with primary biliary cholangitis. J Clin Gastroenterol, 2021, 55(5): 449-457.
37. 蔣卓儒, 張海龍, 朱正陽, 等. 磁共振彈性成像在慢性肝臟疾病中的應用進展. 磁共振成像, 2025, 16(3): 190-195.
38. Poetter-Lang S, Messner A, Bastati N, et al. Diagnosis of functional strictures in patients with primary sclerosing cholangitis using hepatobiliary contrast-enhanced MRI: a proof-of-concept study. Eur Radiol, 2023, 33(12): 9022-9037.
39. Ringe KI, Vo Chieu VD, Wacker F, et al. Fully automated detection of primary sclerosing cholangitis (PSC)-compatible bile duct changes based on 3D magnetic resonance cholangio- pancreatography using machine learning. Eur Radiol, 2021, 31(4): 2482-2489.
40. Cristoferi L, Porta M, Bernasconi DP, et al. A quantitative MRCP-derived score for medium-term outcome prediction in primary sclerosing cholangitis. Dig Liver Dis, 2023, 55(3): 373-380.
41. Cazzagon N, El Mouhadi S, Vanderbecq Q, et al. Quantitative magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in people with primary sclerosing cholangitis. JHEP Rep, 2022, 4(11): 100577. doi: 10.1016/j.jhepr.2022.100577.
42. Selvaraj EA, Ba-Ssalamah A, Poetter-Lang S, et al. A quantitative magnetic resonance cholangiopancreatography metric of intrahepatic biliary dilatation severity detects high-risk primary sclerosing cholangitis. Hepatol Commun, 2022, 6(4): 795-808.
43. Grigoriadis A, Ringe KI, Andersson M, et al. Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis. Eur J Radiol, 2021, 142: 109884. doi: 10.1016/j.ejrad.2021.109884.
44. Eaton JE, Vesterhus M, McCauley BM, et al. Primary sclerosing cholangitis risk estimate tool (PREsTo) predicts outcomes of the disease: a derivation and validation study using machine learning. Hepatology, 2020, 71(1): 214-224.
45. Engel B, Assis DN, Bhat M, et al. Quo vadis autoimmune hepatitis? - summary of the 5th international autoimmune hepatitis group research workshop 2024. JHEP Rep, 2024, 7(2): 101265. doi: 10.1016/j.jhepr.2024.101265.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multimodal imaging and artificial intelligence empowering the diagnosis and treatment of autoimmune liver diseases: research status and prospects

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