How this Oxford spinout is using AI to tackle challenges in non-alcoholic fatty liver disease

Liver biopsy is the current gold standard for assessing liver disease, but the rising burden of non-alcoholic fatty liver disease (NAFLD) –which already has an estimated prevalence of 20-30 percent in the UK – calls for simpler and lower-risk strategies that meet the needs of clinicians and patients.

“We are facing an epidemic of fatty liver disease in this country,” Professor Sir John Bell, Regius professor of medicine at the University of Oxford and author of the UK’s Life Sciences Industrial Strategy, recently commented. “New ways of accurately diagnosing disease early are essential if we want to tackle this growing issue, which is predicted to lead to many more cases of serious liver damage and people needing  liver transplants.”

Oxford-based Perspectum Diagnostics is aiming to tackle this issue with its LiverMultiScan – a test that combines digital image processing and trained experts to quantify and characterise tissue from a standard MRI scan of the liver.

A study published in the journal Alimentary Pharmacology & Therapeutics revealed that LiverMultiScan could almost halve the number of liver biopsies carried out in people with fatty liver disease. The researchers calculate a potential saving of around £150,000 per 1,000 patients.

PharmaTimes spoke to Perspectum’s chairman Professor Sir Michael Brady to learn more about how the company is hoping to change the game in liver disease using AI.

What is the company’s background?

Perspectum Diagnostics is a spin-out company from the University of Oxford, founded in 2012 by world-leading clinicians, physicists, scientists and engineers. The company is dedicated to delivering digital technologies for the better care of patients with liver disease.

Our proprietary technology and flagship product, LiverMultiScan, is a customisable software analysis tool that uses innovative multi-parametric MRI to quickly and accurately measure liver fat as well as correlates of iron, fibrosis and inflammation across the whole liver. LiverMultiScan leverages existing MR hardware and is available to clinicians and researchers across five continents, with centralised, standardised data processing through our Amazon-closed cloud service. Data collected from MRI scans across customer sites are sent securely to Perspectum’s dedicated reporting centre, analysed and returned as patient-friendly reports to physicians.

What drives the company's work?

Our vision is to empower patients and clinicians through harnessing artificial intelligence and computer vision to provide greater understanding of liver disease, enabling early detection, diagnosis and targeted treatment.

What unmet needs are you hoping to address?

We want to support earlier accurate diagnosis and evaluation of liver disease. Non-alcoholic fatty liver disease is on the increase – the prevalence is estimated at around 20-30 percent in the Western world and these numbers are expected to grow. Liver biopsy – the current gold standard for assessing liver disease – is invasive, painful and risky for patients. It’s costly and limited by the fact it assesses just 1/50,000th of the liver.

Our technology has the potential to replace liver biopsy as a diagnostic tool, thereby eliminating risks and pain for patients, and providing physicians with a sensitive diagnostic that looks at the health of the whole liver, not just part of it. Right now there are millions of people with progressive liver disease walking around unaware of the poor health of their liver. LiverMultiScan can be used to help doctors diagnose liver disease, even at the early stages, and can also help  to predict those people whose liver disease is going to progress  more quickly.

We also want to enable new therapies for liver disease. Pharma pipelines are rich with new products to treat non-alcoholic steatohepatitis (NASH). However, clinical studies are hampered by the limitations of liver biopsy which make patient recruitment a challenge. We have partnerships with around 20 pharma companies conducting research in this area who are using our technology to identify patients who are potential candidates for the trial, and to monitor the therapeutic efficacy of their drugs. This reduces costs of trials, speeds up patient recruitment and stops patients from undergoing unnecessary risky and  painful biopsies.

How does your technology use AI?

We are currently testing AI and, more specifically, machine-learning approaches to improve our workflow. These AI approaches include automatic liver segmentation and are showing a lot of potential to automate steps that would otherwise have to be completed manually by an analyst.

A key focus of ours is better quantification of liver disease and AI has potential to further add to our technology for disease discrimination.

What are the main challenges facing AI companies in the industry at the moment?

AI approaches to medical imaging have the potential to be a game changer. Limited access to large and accurately labelled datasets has been a big factor in slowing down the development of robust AI in healthcare in the past. However, this is changing and there is increasing emphasis on managing large datasets and data sharing between institutions for  building AI models.

There are also regulatory challenges for increasingly automated AI approaches to disease analysis. It can be challenging to demonstrate that computer-assisted diagnosis (CADx) devices are accurately diagnosing disease, especially when there are multiple factors influencing the diagnosis beyond imaging such as patient history. However, it is much easier to demonstrate effectiveness for  objective tasks such as organ or pathology delineation to assist  clinical assessment.

What other benefits could it bring?

Digital health will improve the way we practice medicine; in this case,  a painless scan is clearly safer than a biopsy needle and is far better suited to monitoring patients. A LiverMultiScan can help a patient see liver disease and act on it – making lifestyle or treatment choices that might improve their outcomes.

Our technology is being used in research around the world, including in the UK Biobank Imaging Study – the largest population imaging  study in Europe, with over 10,000 scans analysed to date.

What are goals for the future of the company?

Perspectum is committed to continued clinical development across the spectrum of liver disease with ongoing clinical projects in NASH, viral hepatitis, liver cancer, auto-immune and biliary. We  aim to close the loop on drug development by providing the companion diagnostic and biomarkers that both the pharma community and regulators need to bring new therapies to patients more quickly.

Our primary goal is to ensure that people with liver disease can get access to LiverMultiScan wherever they are, so we are working to expand access to our technology across Europe, the USA and Asia.