Abstract
Liver cirrhosis poses a major risk for the development of hepatocellular carcinoma (HCC). This retrospective study investigated to what extent radiomic features allow the prediction of emerging HCC in patients with cirrhosis in contrast-enhanced computed tomography (CECT). A total of 51 patients with liver cirrhosis and newly detected HCC lesions (n = 82) during follow-up (FU-CT) after local tumor therapy were included. These lesions were not to have been detected by the radiologist in the chronologically prior CECT (PRE-CT). For training purposes, segmentations of 22 patients with liver cirrhosis but without HCC-recurrence were added. A total of 186 areas (82 HCCs and 104 cirrhotic liver areas without HCC) were analyzed. Using univariate analysis, four independent features were identified, and a multivariate logistic regression model was trained to classify the outlined regions as “HCC probable” or “HCC improbable”. In total, 60/82 (73%) of segmentations with later detected HCC and 84/104 (81%) segmentations without HCC were classified correctly (AUC of 81%, 95% CI 74–87%), yielding a sensitivity of 72% (95% CI 57–83%) and a specificity of 86% (95% CI 76–96%). In conclusion, the model predicted the occurrence of new HCCs within segmented areas with an acceptable sensitivity and specificity in cirrhotic liver tissue in CECT.
Highlights
Hepatocellular cancer (HCC) is the second most lethal tumor, the sixth most diagnosed cancer worldwide [1], and the primary malignant liver tumor in liver cirrhosis [2]
85 patients with liver cirrhosis and newly developed hepatocellular carcinoma (HCC) during contrast-enhanced computed tomography (CECT) surveillance were screened for eligibility
Thirty-four patients were excluded due to a period ≥ 300 days between previous CT” (PRE-CT) and follow-up CT” (FU-CT) (n = 19), atypical image features according to Liver Imaging Reporting and Data System (LI-RADS) (n = 7), retrospectively detectable HCC lesion in PRE-CT (n = 5), CTs with a slice thickness >3 mm (n = 2) and inadequate arterial contrast phases (n = 1)
Summary
Hepatocellular cancer (HCC) is the second most lethal tumor, the sixth most diagnosed cancer worldwide [1], and the primary malignant liver tumor in liver cirrhosis [2]. Each year approximately 1–8% of patients with liver cirrhosis and no signs of liver failure develop HCC [3], corresponding to an approximate 30% risk of developing HCC during one’s lifetime in the presence of cirrhosis [4]. Due to the high risk of HCC development in patients with liver cirrhosis, screening is recommended at regular intervals [3,5]. In a meta-analysis, surveillance has been proven to increase the detection rate of subclinical early-stage HCC and facilitate curative treatment compared with no surveillance [6]. The Barcelona Clinic Liver Cancer (BCLC) staging system is the most used classification with first-line treatment recommendations [7,8]. For all treatment options to be applicable, a solitary lesion is detected at a very early stage with
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