Abstract
PurposeThis study aimed to develop a radiomics nomogram based on contrast-enhanced ultrasound (CEUS) for preoperatively assessing microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients.MethodsA retrospective dataset of 313 HCC patients who underwent CEUS between September 20, 2016 and March 20, 2020 was enrolled in our study. The study population was randomly grouped as a primary dataset of 192 patients and a validation dataset of 121 patients. Radiomics features were extracted from the B-mode (BM), artery phase (AP), portal venous phase (PVP), and delay phase (DP) images of preoperatively acquired CEUS of each patient. After feature selection, the BM, AP, PVP, and DP radiomics scores (Rad-score) were constructed from the primary dataset. The four radiomics scores and clinical factors were used for multivariate logistic regression analysis, and a radiomics nomogram was then developed. We also built a preoperative clinical prediction model for comparison. The performance of the radiomics nomogram was evaluated via calibration, discrimination, and clinical usefulness.ResultsMultivariate analysis indicated that the PVP and DP Rad-score, tumor size, and AFP (alpha-fetoprotein) level were independent risk predictors associated with MVI. The radiomics nomogram incorporating these four predictors revealed a superior discrimination to the clinical model (based on tumor size and AFP level) in the primary dataset (AUC: 0.849 vs. 0.690; p < 0.001) and validation dataset (AUC: 0.788 vs. 0.661; p = 0.008), with a good calibration. Decision curve analysis also confirmed that the radiomics nomogram was clinically useful. Furthermore, the significant improvement of net reclassification index (NRI) and integrated discriminatory improvement (IDI) implied that the PVP and DP radiomics signatures may be very useful biomarkers for MVI prediction in HCC.ConclusionThe CEUS-based radiomics nomogram showed a favorable predictive value for the preoperative identification of MVI in HCC patients and could guide a more appropriate surgical planning.
Highlights
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and ranks third among all cancer-related deaths [1, 2]
This study aimed to develop a radiomics nomogram based on contrastenhanced ultrasound (CEUS) for preoperatively assessing microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients
Multivariate analysis indicated that the portal venous phase (PVP) and delay phase (DP) Rad-score, tumor size, and a-fetoprotein level (AFP) level were independent risk predictors associated with MVI
Summary
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and ranks third among all cancer-related deaths [1, 2]. It has always been a major international health problem. It is very important to detect high-risk factors for early recurrence before surgery to enable the formulation of individualized treatment plans. Some studies have confirmed that MVI is an essential determinant for predicting early recurrence and evaluating the long-term survival of HCC patients [6, 7]. Unlike macrovascular invasion, which can usually be detectable with preoperative imaging, MVI can only be determined according to postoperative pathological specimens [10]. Preoperative biopsy is unreliable due to sampling errors [11]
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