Abstract
BackgroundNuclear protein Ki-67 indicates the status of cell proliferation and has been regarded as an attractive biomarker for the prognosis of HCC. The aim of this study is to investigate which radiomics model derived from different sequences and phases of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI was superior to predict Ki-67 expression in hepatocellular carcinoma (HCC), then further to validate the optimal model for preoperative prediction of Ki-67 expression in HCC.MethodsThis retrospective study included 151 (training cohort: n = 103; validation cohort: n = 48) pathologically confirmed HCC patients. Radiomics features were extracted from the artery phase (AP), portal venous phase (PVP), hepatobiliary phase (HBP), and T2-weighted (T2W) images. A logistic regression with the least absolute shrinkage and selection operator (LASSO) regularization was used to select features to build a radiomics score (Rad-score). A final combined model including the optimal Rad-score and clinical risk factors was established. Receiver operating characteristic (ROC) curve analysis, Delong test and calibration curve were used to assess the predictive performance of the combined model. Decision cure analysis (DCA) was used to evaluate the clinical utility.ResultsThe AP radiomics model with higher decision curve indicating added more net benefit, gave a better predictive performance than the HBP and T2W radiomic models. The combined model (AUC = 0.922 vs. 0.863) including AP Rad-score and serum AFP levels improved the predictive performance more than the AP radiomics model (AUC = 0.873 vs. 0.813) in the training and validation cohort. Calibration curve of the combined model showed a good agreement between the predicted and the actual probability. DCA of the validation cohort revealed that at a range threshold probability of 30–60%, the combined model added more net benefit compared with the AP radiomics model.ConclusionsA combined model including AP Rad-score and serum AFP levels based on enhanced MRI can preoperatively predict Ki-67 expression in HCC.
Highlights
Nuclear protein Ki-67 indicates the status of cell proliferation and has been regarded as an attractive biomarker for the prognosis of hepatocellular carcinoma (HCC)
This study aimed to develop and compare predictive performance of radiomics models derived from different sequences and phases based on Gd-EOB-DTPAenhanced MRI, to further validate the optimal model for preoperative prediction of Ki-67 expression in patients with HCC
Among all 151 patients, high Ki-67 expression was pathologically diagnosed in 112 patients (74.2%), low Ki-67 expression was pathologically diagnosed in 39 patients (25.8%)
Summary
Nuclear protein Ki-67 indicates the status of cell proliferation and has been regarded as an attractive biomarker for the prognosis of HCC. The aim of this study is to investigate which radiomics model derived from different sequences and phases of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)enhanced MRI was superior to predict Ki-67 expression in hepatocellular carcinoma (HCC), further to validate the optimal model for preoperative prediction of Ki-67 expression in HCC. The poor prognosis of HCC after surgical resection is mainly due to recurrence and metastasis [2, 3]. Nuclear protein Ki-67 expression level- indicates the. Fan et al BMC Med Imaging (2021) 21:100 status of cell proliferation activity which corresponds with tumor biological behavior, treatment efficacy and prognosis [4, 5]. It is difficult to differentiate the nuances among HCCs with different Ki-67 expression through conventional imaging
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