An Attention-Residual Hybrid CNN for CT-Based Multiclass Classification of Alcohol-Related Liver Disease: Differential Diagnosis Against HBV-Related Cirrhosis

Background: Differentiating alcohol-related liver disease (ARLD) from chronic liver injury caused by other etiologies remains a clinically relevant challenge in cross-sectional imaging. In particular, alcoholic hepatitis and alcoholic cirrhosis may overlap morphologically with HBV-related cirrhosis on CT imaging. To develop and assess an attention-residual hybrid Convolutional Neural Network (CNN) for multiclass CT image classification of alcoholic hepatitis, alcoholic cirrhosis, HBV-related cirrhosis, and living liver donors. Methods: A four-class liver image dataset comprising 5760 CT images from 144 individuals (36 per group) was constructed using images from alcoholic hepatitis, alcoholic cirrhosis, HBV-related cirrhosis, and living liver donors. The dataset was partitioned into training, validation, and test sets at the patient level. Five pretrained CNN architectures, including DenseNet121, ResNet50, MobileNetV3-Large, EfficientNetB0, and ConvNeXt-Tiny, were first fine-tuned and comparatively evaluated. Based on F1-score ranking, DenseNet121 and ConvNeXt-Tiny were selected as the two backbone networks for the proposed hybrid model. The final architecture integrated Attention Pooling, Feature-wise Linear Modulation (FiLM), Multi-head Attention, Gated Linear Units, Residual Connections, and layer normalization to improve feature fusion and contextual representation. Results: The proposed model demonstrated the best overall performance among all evaluated architectures on the test set. It achieved an accuracy of 99.55%, a weighted F1-score of 99.55%, an MCC of 0.9941, and a Cohen’s kappa coefficient of 0.9940. The model also achieved ROC-AUC and PR-AUC values of 100.00% and 99.99%, respectively, together with an NPV of 99.85%. The proposed model’s performance was also balanced across classes. For Alcoholic Cirrhosis, precision, recall, and F1-score were all 99.64%. For Alcoholic Hepatitis, the corresponding values were 100.00%, 98.93%, and 99.46%, respectively, while HBV-related Cirrhosis achieved 99.29% precision, 99.64% recall, and 99.47% F1-score. Living Liver Donors achieved 99.29% precision, 100.00% recall, and 99.64% F1-score. Conclusions: The findings of this exploratory study suggest that routine CT images may contain image-based differences potentially relevant to etiology-oriented classification of diffuse liver disease. Beyond distinguishing ARLD from HBV-related cirrhosis and images from living liver donors, the model also captured image-based differences between major ARLD subgroups, including alcoholic hepatitis and alcoholic cirrhosis. These findings support further investigation of CT-derived image-based differences in larger independent and multicenter datasets.