International Conference on Communication and Signal Processing, April 6-8, 2017, India
A Study of the Phases of Classification of Liver
Diseases from Ultrasound Images and Gray
Level Difference Weights Based Segmentation
Midhila.M, Raghesh Krishnan K and R.Sudhakar
 non-invasive, cost effective, portable and popular technique
Abstract— This paper presents a study of the state of the art
techniques applied to computer based analysis and classification
of liver diseases from ultrasound images. The diseased portions
from the ultrasound images are analyzed and categorized using
techniques such as Despeckling, Segmentation, Feature extraction
and Classification. Automatic segmentation of ultrasound images
is complicated due to the fact that the image may include other
organs which are close to the liver, irregular structure of disease,
poor quality of image, lack of color cues, and lack of definite
boundaries and presence of noise. This work makes a study of
different techniques used in the different phases of biomedical
liver ultrasound processing such as noise removal, segmentation,
Feature Extraction and classification. This work also presents the
segmentation results obtained using Gray Level Difference
Weights Method on 10 types of liver diseases from ultrasound
images.
Index Terms— Ultrasound images; Liver disease;
Segmentation; Classification; Despeckling; Gray level difference
weights.
I. INTRODUCTION
L iver is one of the largest and most important internal organs
in the human body. Malfunctioning of the liver affects
almost all the other organs in the human body. Liver
disorders are typically classified into two categories namely
focal disorders and diffused disorders. Focal liver diseases
such as hemangioma, hepatitis and cyst are confined to small
regions of the liver surface whereas the diffused liver disorders
such as fatty liver and cirrhosis, affect major portions of the
liver without any definite shape or confinement. Liver diseases
are often difficult to diagnose due to indefinite symptoms or
could be easily mistaken for symptoms of other disease. Often
times,
the liver might be already facing considerable damages
without any significant symptoms. Ultrasound imaging is a
Midhila.M, Raghesh Krishnan k are with the Department of Computer
Science and Engineering, Amrita School of Engineering, Coimbatore
Amrita Vishwa Vidyapeetham, Amrita University, India
(email:cb.en.p2cvi15005@cb.students.amrita.edu, k_raghesh@cb.amrita.edu)
R.Sudhakar is with the Department of Electronics and Communication
Engineering, Dr.Mahalingam College of Engineering and Technology
Udumalai Road, Pollachi-642003, Tamilnadu, India
(email: sudhakar.radhakrishnan@gmail.com)
978-1-5090-3800-8/17/$31.00 ©2017 IEEE
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(due to the aforesaid reasons) employed in the primary
diagnosis of liver disorders. It uses high frequency sound
waves to visualize the soft tissues inside the human viscera.
The images are captured in real time and help the physician to
analyze blood flow and movements of internal organs. The
amount of risk and discomfort involved in an ultrasound based
diagnosis is less in comparison with biopsy. One of the major
applications of ultrasound based diagnostics is in liver imaging
and fetal development. Clinical diagnosis is made on the basis
of visual perception. Isolation of the diseased region,
especially in focal disorders normally requires segmentation. A
segmented image can provide more focus on the diseased
portion thereby aiding the physicians in better analysis in
assisted diagnosis. Image processing plays a vital role in
medical diagnosis. In the case of computer aided classification
systems, segmentation plays a vital role in enhancing the
accuracy by focusing on the diseased portion for the
subsequent step of feature extraction thereby eliminating all
the surrounding regions of lesser interest which can contribute
to misclassification. Low contrast, missing boundaries and
noise complicate the task of medical image segmentation. In a
computer aided system, segmentation is followed by feature
extraction and classification. Extraction of robust features
results in better classification accuracy provided the
classification mechanism is robust enough to handle the
complex similarities and differences of medical images
especially liver ultrasound images.
Selective surveys in different perspectives of automated
diagnosis such as despeckling, automatic liver segmentation,
Region of Interest (ROI) identification, feature extraction and
classification have been attempted by various researchers. This
paper presents a survey of the methods used in the recent past
for segmentation, feature extraction and classification of liver
disorders from ultrasound images. The section II describes the
literature survey and section III concludes the paper.
II. REVIEW OF LITERATURE SURVEY
Computer based classification of liver diseases from
ultrasound images using image processing techniques
generally involves the phases of despeckling, enhancement,
ROI detection or segmentation, feature extraction and
classification. This survey presents the various methods
adapted in the recent past to perform the above tasks.
 A. PREPROCESSING TECHNIQUES
Ultrasound images are prone to degradation by a
multiplicative noise known as speckle noise. Speckle noise is
produced as a result of interference between ultrasound pulses
from closely spaced reflectors. This section presents a study of
various filtering techniques used for speckle noise removal
from ultrasound images. Some of the well known filters used
for speckle reduction in the literature include Kuan, Lee,
Gamma MAP Median, standard Frost, Weiner, Enhanced
Frost, and SRAD filters. Despeckling techniques such as
Anisotropic Diffusion, modified techniques such as Speckle
Reduction Anisotropic Diffusion (SRAD) and Enhanced stick
filter also find their frequent application in preprocessing
stage. Deepti et al. [1] use a modified SRAD method. The
existing method is SRAD, which is commonly used as a non-
linear image processing technique. This technique mainly
focuses on noise removal and maintains edges. The modified
SRAD technique produces images without blurring and the
fine details in the image can be visualized more clearly. The
performance comparison of MSRAD and SRAD on ultrasound
images is achieved by computing beta metrics, a figure of
merit and correlation coefficient. Aksel et al. [2] defined an
algorithm called windowed SRAD which considers a large
local neighborhood. The technique eliminates the diffused
feature edges thereby enhancing the accuracy in the
segmentation of echocardiographic images. The accuracy
obtained is 94%. Sharma et al. [3] implement an Enhanced
stick algorithm for denoising noisy ultrasound images. A linear
array is categorized into two portions called sticks and
possible outcomes.The proposed method is found to provide
better perfomance in noise reduction and accuracy rate.
Prathap et al. [4] implement a non linear multidimensional
filter known as peak and valley method for noise reduction.
The technique uses an improved Otsu’s algorithm for
segmentation. The system is a fully automated one and can
replace the median filter in order to improve the efficiency.
The technique classifies liver images into normal liver or a
tumor and acquires an overall accuracy of 85%. Garg et al. [5]
propose a despeckling approach for ultrasound images by
using a wiener filter and applys thresholding in discrete
wavelet transform domain. The image used for experiment
contains speckle noise ranging from 5% to 30%. Benzarti and
Amiri [6] design a method that combines a diffusion tensor
and logarithmic transformation. The objective is to allow
diffusion along with the orientation of greatest coherence
under additive noise condition. The tensor structure provides a
powerful description of local image patterns. Meriem et al. [7]
propose a new method that integrates a data misfit function
and weighted total variation function. A multiplicative
regularization method is used for image denoising and it
preserves the region boundary. Mitiche et al. [8] present a
wavelet based technique that uses a Dual Tree Complex
Wavelet Transform and shrinkage (DTCWT). The method
retains a balance between accuracy and smoothness. DTCWT
is an enhanced model of discrete wavelet transform and has
additional properties of directional selectivity in high
dimensions and is shift invariant. Universal thresholding is
applied to the images, which is a simple entropy measure. The
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threshold value depends entirely on the size of the signal.
Smriti et al. [9] study three image enhancement techniques
namely shock filter, spatial filter and Contrast Limited
Adaptive Histogram Equalization. In [10] the aim is to
compare the performance of different denoising techniques for
ultrasound images. The technique includes five filters such as
Gaussian, median, wiener, shock and butter worth low pass
filters. A comparison table of filters is constructed with values
of PSNR and MSE of the input image and filtered image.
Gaussian filters are found to have better PSNR values for the
images.
B. SEGMENTATION
Segmentation is the process of dividing an image into one or
more regions thereby making the task of image analysis easier.
A variety of segmentation techniques such as texture based
techniques, improved Otsu’s algorithm, automatic
segmentation etc., exist in the literature.
L.Massoptier et al. [11] proposed an automatic
segmentation method. Liver segmentation possesses more
complexity to separate the regions due to the low contrast with
adjacent organs present inside the human body. Ribeiro et al.
[12] segments the images using a semi – automatic approach.
The extracted features are used along with the laboratory data
for identifying the disease from ultrasound images. A
comparison is made using different classifiers such as Support
Vector Machine (SVM), k-nearest neighbour (k-nn) and
bayesian. The best result is obtained using k-nn with accuracy
of 80.68%. Raghesh and Sudhakar in [13] implement
Isocontour segmentation based on marching squares and
thresholding for classification of ten types of focal and
diffused liver diseases. From the segmented regions,
GrayLevelCo-occurenceMatrix (GLCM) and fractal features
are extracted and classified using SVM and artificial neural
networks. The accuracy attained by the implementation is
92%. Mandeep et al. in [14] focus on the region of interest
(ROI) of the image. Aggarwal et al. [15] provide an automatic
system for liver disease prediction. The system includes a
training procedure and automatic ROI detection. The final
image is classified with the textures present in the image using
svm and obtains an accuracy of 92.4%. Ali et al. [16]
developed an automated method for the diagnosis of normal
liver and focal liver diseases like Hepatocellularcarcinoma
(HCC), Cyst and Hemangioma. The ROI is selected with the
help of fuzzy c-means and level set method. The system yields
an accuracy of 96.11%. Guodong et al. [17] design a shape
model design for segmentation. The method uses thresholding
and Euclidean distance transform for identifying the position
of the disease affected region. For detecting the exact position,
deformable graph cut method is used. The images for
evaluation are obtained from the Sliver07 and 3Dircadb
database. Ananth et al. [18] work on a methodology known as
Geodesic Graph cut method. The edge information and
geodesic distance are combined with a graph cut framework.
The proposed geodesic graph cut can improve the
computerized visualizations for noninvasive diagnosis of
hepatic tumors and proves to be a better segmentation
technique compared to fully automatic systems. The accuracy
obtained for liver segmentation is 96.1% and for tumor it is
92.3%. In [19] the method consists of three steps such as
texture analysis, calculation of liver distribution and liver
organ localization. The technique is selective in both global
and local texture distribution. The proposed method segments
the image with an accuracy of 97.3% on true positive volume
fraction. In [20] the algorithm reduces the image using
morphological erosion and intensity analysis. The images of
benign and malignant lesions of size 512x512 are used. The
liver is segmented by connected region growing method and
for segmenting lesions; Fuzzy C-Means clustering is used.
C. FEATURE EXTRACTION
The features used to describe the regions obtained after
segmentation can be textural analysis, first order statics such as
mean, standard deviation, higher order statical features such as
Haralick, Gray Level Co-Occurrence Matrix (GLCM),
GLRLM and combination of one or more features such as
GLCM and fractal features.
Mandeep et al. in [21] deal with texture analysis and use
seven features, based on the linear discriminant analysis. The
proposed method combines the best features from different
textures that are used in the dataset. In Icer et al. [22], a
combination of GLCM and fractal features are analyzed. The
method designs a quantitative graduation system based on gray
relational analysis to identify fatty livers. Priyanjana et al. [23]
present CAD systems that can be used for diagnosis of focal
liver lesion from CT images and B-mode ultrasound images. In
this work, classification of four types of hepatic tissues such as
normal liver, hepatic cyst, hemangioma and HCC is analyzed.
A set of texture features consisting of five texture analysis
methods such as First order statics, Spatial Gray-Level
Dependence Matrix (SGLM), Gray-Level Difference Matrix ,
Law’s Texture Energy Measures and Fractal Dimension
Measurements are extracted from the ROI. The system can
decrease the interpretation time and improves diagnostic
specificity and sensitivity. Ali et al. [24] developed an
automated method for the diagnosis and classification of liver
lesions using Multi-SVM. The ROI selection is done using
fuzzy c-means and level set methods. The features extracted
are 22 Haralick features and a histogram feature and given to
the SVM classifier which reports a classification accuracy of
96.11%. Karule and Hardeep [25] developed an optimal neural
network based decision support system, which seems to be a
precise and reliable method for diagnosis of cirrhosis and
chronic active hepatitis. The neural network is trained by eight
texture features, extracted from five different regions of
interests in each B-mode ultrasonic image of normal liver,
cirrhosis and Chronic Active Hepatitis (CAH). The proposed
Multilayer perception neural network gives an accuracy of
96.55% and it is computationally simple. Ravindran et al. [26]
attempt to identify cysts, cancers, and tumours by analysing
their unique echo texture patterns using back propagation
neural network classifier. Four feature selection methods
including GLCM, GLRLM, Gabor wavelet, and Law’s spectral
texture features are used. The use of combined features yields
a better rate of classification nearly 83%. In Aborisade et al.
[27], GLCM method is used to extract textural features such as
entropy, energy, dissimilarity, contrast, correlation, cluster
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shade. US images are categorized into normal liver, HCC and
primary liver cell carcinoma (PLCC). The diagnosis is made
on the basis of diagnostic indices – False Negative Rate,
Specificity, False Positive Rate and Sensitivity of 60%.
Suganya and Rajaram [28] introduce a hybrid approach made
of SVM and Relevance feedback method. Fractal based
geometry features, GLCM and first order statistics are used to
differentiate liver cyst from alchoholic cirrhosis and
carcinoma. with an accuracy of 72.1%. In [29] parameters of
ultrasound images are determined with the help of a novel
combination of features based on wavelet, higher order spectra
and texture. The method classifies the liver disease into normal
and Fatty liver. The technique achieves an accuracy of 93.3%.
Maggi et al. [30] make an experimental comparison of
different texture models such as GLCM, GLDS, Spatial Gray
Level Co-occurrence Matrix (SGLCM), first order Statics,
Foureir Power Spectrum (FPS) for Content Based Medical
Image Retrieval. Among the various features analyzed,
SGLCM and FPS are found to be suitable for liver ultrasound
image retrieval.
D. CLASSIFICATION
The process of grouping the images based on the similarity
of features is known as classification. A wide variety of
classification mechanisms are found in the literature. This
section addresses the classification techniques frequently
applied to liver disease classification of ultrasound images.
Huang et al. [31] employ two classifiers SVM and k-nn for
classification. The classified images are grouped on the basis
of classifiers and performance of two classifiers is compared.
The method reports an accuracy of 82.5%. A semi automatic
procedure is adopted by Ricardo et al. in [32]. The algorithm
uses two classifiers such as k-NN and a SVM with different
kernels. The features extracted from the images are tabulated
according to the clinical information. The classifier identifies
the liver disease by maximizing the sensitivity rate. Allan et al.
in [33] implement a method for diagnosing the accuracy of
ultrasound imaging for chronic liver diseases. The technique
uses a quality assessment of diagnostic study by answering a
set of questions related to the disease which says yes, no or
unclear and provides a graphical representation of diagnostic
data using receiver operator characteristic plots. The results
are obtained on the basis of a score is given to the answers.
The specificity obtained by the sysytem is 97.6% and
sensitivity of 87.8% Andreia et al. [34] presents a semi-
automatic classification method to evaluate steatosis liver
tissues. First order statistical features namely mean, median
and texture features such as GLCM, GLRLM are extracted and
classified using SVM, Artificial networks and k-NN. To
determine the features which have a significant relation
between the classes, a statistical regression technique is used.
Jitendra et al. [35] extract the ROI from image classes and
extract wavelet packet texture descriptors such as mean,
standard deviation and energy features computed from various
filters including Haar, Daubechies, biorthogonal, symlets and
coiflets. The dataset consist of normal, HCC and cirrhotic liver
US. The work mentions an increased accuracy and sensitivity
with an overall accuracy of 88.8%. Kumar and Moni [36] use
a Fast Discrete Curvelet Transform (FDCT) for the liver disease using SVM and Naïve Bayes classifiers. The
classification of tumor into heptoma and hemangioma.The algorithm is compared based on the two factors namely
algorithm used is a wrapping transform known as wrapping accuracy and execution time. SVM gives a better classification
discrete curvelet transform. The accuracy obtained by applying accuracy of 79.6%. Dhamodharan [39] deals with the Naïve
the FDCT technique is 93.3%. Reetu and Narender [37] model bayes and Functional Trees (FT) Algorithm for classifying
a classification mechanism using Decision Tree Induction on liver disease into Liver cancer, Hepatitis and Cirrhosis. Naïve
Liver Cancer Datasets using Waikato Environment for bayes gives a better accuracy rate of 75.4% in comparison with
Knowledge Acquisition (WEKA). The J48 classifier algorithm FT algorithm. In [40], classification algorithms such as SVM,
is used for classification with a basic c4.5 decision tree Naïve Bayes, Decision trees and Back propagation Neural
induction. The algorithm divides the data samples based on the Networks are analyzed on UCLA liver dataset. The
attribute value into 100 training samples and 50 test samples. combination of KNN, SVM and Back propogation gives a
The method is found to be flexible for application on large better classification rate based on the values of Accuracy,
datasets and can combine one or more classification Specificity and Precision. TABLE I summarizes different
techniques to improve the performance and high accuracy. techniques used in the above sections.
Vijayarani and dhayanand [38] implement a prediction for
TABLE I
SUMMARY OF THE ACCURACIES OBTAINED USING VARIOUS TECHNIQUES IN THE PHASES OF CLASSIFICATION
Approach Author Disease classified Technique used Accuracy (%)
Aksel et al. [2] Normal liver Windowed SRAD 94
Prathap et al. [4] Normal or a Tumor liver Peak and valley method 85
Pre-processing Benzarti and Amiri [6] Normal liver Diffusion tensor & logarithmic 80
transformation
Raghesh et al. [13] 10-focal and diffused liver Isocontour segmentation 92
Aggarwal et al. [15] Normal liver Training procedure& automatic ROI 92.4
Segmentation detection
Ananth et al. [18] Hepatictumors & Normal liver GeodesicGraph cut method 92.3

Feature Extraction Ravindran et al. [26]
Suganya andRajaram [28]
Acharya et.al[29]
Cysts, Cancers, and tumours
Cyst,cirrhosis and carcinoma
Normal and Fatty liver
GLCM, GLRLM, Gabor wavelet, and 83
Law’s spectral texture features
Fractal based geometry features, GLCM 72.1
and first order statistics
Novel combination of features based on 93.3
wavelet, higher order spectra and texture.

Classification Vijayarani and dhayanand [38] Normal liver SVM and Naïve Bayes classifiers 79.6

Kumar and Moni [36] Heptoma and Hemangioma. Fast Discrete Curvelet Transform 93.3
Dhamodharan. S[39] Cancer, Hepatitis and Cirrhosis Naïve bayes & Functional Trees 75.4

The accuracy obtained from different classifiers is

represented in the Fig.1. From the graph we can conclude E. Gray Difference Weight segmentation
that SVM classifier yields a better perfomance rate
compared to the other classifiers. The method segments an object in an image using Fast
Marching Method (FMM) [41] using grayscale intensity
difference weights. The row and column index of pixels are
specified for a refrence grayscale intensity value. Threshold
for absolute grayscale intensity difference values, specified
as a non – negative scalar of class double. The above
parameter puts a hard threshold on the absolute grayscale
intensity difference values, and strongly suppresses the
output weight value for any pixel whose absolute grayscale
intensity difference from the reference grayscale intensity is
greater than the cutoff by assigning them the smallest weight
value. When the output weight array W is used for FMM
based segmentation (as input to imsegfmm), this parameter
Fig. 1. Accuracy using Classification

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can be useful in improving the accuracy of the segmentation
output. The segmentation works for the diseases like cyst,
hcc, echinococcosis and cirrhosis. The results obtained are
tabulated in Table II. The liver disease like abscess, fatty
liver, hepatitis, metastasis, hemangioma doesnot works well
for gray level difference weight segmentation because of the
intensity difference and nature of disease present in US
images.
TABLE II
. RESULTS FOR GRAY LEVEL DIFFERENCE WEIGHTS
Disease Input image Output image
Cyst
HCC
Echinococcosis
Cirrhosis
Fig. 2. Segmentation Accuracy for Different Diseases
Fig.2. represents the segmentation accuracy of different
diseases using gray level difference weight method. The
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diseases like cyst with an accuracy of 80%, hcc of 55% and
echinococcosis of 60% are having better accuracy rate
compared to other diseases. The method works well for
focal liver diseases than diffused liver diseases.
III. CONCLUSION
In this paper review of existing literature of diagnosing
the liver disease based on the ultrasound image has been
made. For proper segmentation a thorough understanding of
image is necessary. The features extracted from the
segmented regions are used for the classification of liver
disease. We hope that this review will help researchers to
have an understanding of the currently used techniques for
identifying the disease affected region. This study shows
that there is an immense scope for further research to
identifying different liver diseases by using ultrasound
images. The results obtained using the gray difference
method is verified with the help of a physician. The fig2
contains the segmentation accuracy which is obtained after
the verification of the segmented region with the orginal
image.
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