# AI-based denoising improves image quality in HCC volume perfusion CT without affecting Milan classification

## TL;DR

AI-based denoising improves the image quality of liver CT scans for HCC without affecting diagnostic accuracy or classification.

## Contribution

AI denoising enhances VPCT image quality without altering HCC diagnosis or Milan classification.

## Key findings

- AI denoising significantly improved subjective and objective image quality metrics compared to standard methods.
- No significant differences were found in lesion diameter or Milan classification across reconstruction methods.
- AI denoising did not compromise diagnostic capabilities for HCC.

## Abstract

Noise and artifacts often compromise image quality and diagnostic accuracy in liver Volume Perfusion CT (VPCT), which can impact clinical decision-making in the diagnosis of hepatocellular carcinoma (HCC). AI-based denoising can potentially improve image quality in computed tomography imaging. Therefore, we aimed to evaluate the effects of AI denoising (AID) on image quality and Milan classification in VPCT compared to standard methods.

VPCT examinations from 100 patients acquired between 2017 and 2021 were retrospectively included in the analysis. Perfusion maps were reconstructed using original data (Origin), vendor-specific median filtration (Vendor), and AID. Two radiologists independently scored subjective image quality (image quality, diagnostic confidence, contrast, and sharpness). Objective image quality parameters (CT numbers, noise, contrast-to-noise ratios) and diameters of all HCC lesions were measured across all datasets. Additionally, the Milan classification was determined for each patient.

AID enhanced subjective image quality (0.48 ± 0.29) compared to Origin (-0.31 ± 0.29, p-value < 0.001) and Vendor (-0.17 ± 0.24, p-value < 0.001). CNR was higher in AID (27.40 ± 2.98) compared to Origin (16.98 ± 1.54, p < 0.001) and Vendor (19.43 ± 1.79, p < 0.001). No significant differences were found regarding lesion diameter between Origin, Vendor, and AID (p > 0.999). The number and localization of HCC lesions were equal between Origin, Vendor, and AID. The different reconstruction methods did not affect Milan classification.

AID enhances the image quality of HCC liver VPCT without compromising diagnostic capabilities and may support the evaluation of VPCT in the diagnosis of HCC.

The online version contains supplementary material available at 10.1186/s12880-025-02138-6.