Artificial intelligence-assisted digital pathology for non-alcoholic steatohepatitis: current status and future directions

Vlad Ratziu, Marcus Hompesch, Mathieu Petitjean, Cindy Serdjebi, Janani S. Iyer, Anil V. Parwani, Dean Tai, Elisabetta Bugianesi, Kenneth Cusi, Scott L. Friedman, Eric Lawitz, Manuel Romero-Gómez, Detlef Schuppan, Rohit Loomba, Valérie Paradis, Cynthia Behling, Arun J. Sanyal

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


The worldwide prevalence of non-alcoholic steatohepatitis (NASH) is increasing, causing a significant medical burden, but no approved therapeutics are currently available. NASH drug development requires histological analysis of liver biopsies by expert pathologists for trial enrolment and efficacy assessment, which can be hindered by multiple issues including sample heterogeneity, inter-reader and intra-reader variability, and ordinal scoring systems. Consequently, there is a high unmet need for accurate, reproducible, quantitative, and automated methods to assist pathologists with histological analysis to improve the precision around treatment and efficacy assessment. Digital pathology (DP) workflows in combination with artificial intelligence (AI) have been established in other areas of medicine and are being actively investigated in NASH to assist pathologists in the evaluation and scoring of NASH histology. DP/AI models can be used to automatically detect, localise, quantify, and score histological parameters and have the potential to reduce the impact of scoring variability in NASH clinical trials. This narrative review provides an overview of DP/AI tools in development for NASH, highlights key regulatory considerations, and discusses how these advances may impact the future of NASH clinical management and drug development. This should be a high priority in the NASH field, particularly to improve the development of safe and effective therapeutics.

Original languageEnglish (US)
Pages (from-to)335-351
Number of pages17
JournalJournal of Hepatology
Issue number2
StatePublished - Feb 2024


  • NASH
  • artificial intelligence
  • ballooning
  • clinical trials
  • digital pathology
  • fibrosis
  • histology
  • inflammation
  • liver biopsy
  • machine learning
  • steatosis

ASJC Scopus subject areas

  • Hepatology


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