Generalization of deep learning models for hepatic steatosis grading using B-mode ultrasound images

Grayscale ultrasound remains a key modality for screening of hepatic steatosis due to its non-invasiveness and availability. While neural networks have shown promise in this field, their main drawback lies in their inability to generalize to diverse real-world settings. Variations in equipment, acquisition parameters, or population significantly affect model performance. Test-time adaptation, an unsupervised domain adaptation technique, overcomes these limitations by adjusting trained models during inference. Our retrospective study used two datasets collected in separate populations, with different scanners and protocols. We propose an adaptation method, using test-time batch normalization to selectively adjust BatchNorm layers based on test data for predicting steatosis grades. Comparing the non-adapted and adapted models, the mean absolute error (± standard deviation) in grading four severities of steatosis decreased from 0.92 ± 0.21 to 0.64 ± 0.22 . Specifically, for detection of steatosis the area under the curve increased from 0.76 ± 0.05 to 0.95 ± 0.02 when using the adapted model. Adapted models show promising results in improving performance compared to base models when testing data differ significantly from training data. Results suggest that the proposed method effectively addresses domain shift in diagnosing fatty liver using ultrasound images, reducing risks associated with deploying trained models.