Multi-scale and multi-parametric radiomics of gadoxetate disodium-enhanced MRI predicts microvascular invasion and outcome in patients with solitary hepatocellular carcinoma ≤ 5 cm

Objectives: To develop radiomics-based nomograms for preoperative microvascular invasion (MVI) and recurrence-free survival (RFS) prediction in patients with solitary hepatocellular carcinoma (HCC) <= 5 cm. Methods: Between March 2012 and September 2019, 356 patients with pathologically confirmed solitary HCC <= 5 cm who underwent preoperative gadoxetate disodium-enhanced MRI were retrospectively enrolled. MVI was graded as M0, M1, or M2 according to the number and distribution of invaded vessels. Radiomics features were extracted from DWI, arterial, portal venous, and hepatobiliary phase images in regions of the entire tumor, peritumoral area <= 10 mm, and randomly selected liver tissue. Multivariate analysis identified the independent predictors for MVI and RFS, with nomogram visualized the ultimately predictive models. Results: Elevated alpha-fetoprotein, total bilirubin and radiomics values, peritumoral enhancement, and incomplete or absent capsule enhancement were independent risk factors for MVI. The AUCs of MVI nomogram reached 0.920 (95% CI: 0.861-0.979) using random forest and 0.879 (95% CI: 0.820-0.938) using logistic regression analysis in validation cohort (n = 106). With the 5-year RFS rate of 68.4%, the median RFS of MVI-positive (M2 and M1) and MVI-negative (M0) patients were 30.5 (11.9 and 40.9) and > 96.9 months (p < 0.001), respectively. Age, histologic MVI, alkaline phosphatase, and alanine aminotransferase independently predicted recurrence, yielding AUC of 0.654 (95% CI: 0.538-0.769, n = 99) in RFS validation cohort. Instead of histologic MVI, the preoperatively predicted MVI by MVI nomogram using random forest achieved comparable accuracy in MVI stratification and RFS prediction. Conclusions: Preoperative radiomics-based nomogram using random forest is a potential biomarker of MVI and RFS prediction for solitary HCC <= 5 cm.

Automated summary

The study successfully developed radiomics-based nomograms for predicting preoperative microvascular invasion and recurrence-free survival in patients with solitary hepatocellular carcinoma <= 5 cm. Radiomics values, peritumoral enhancement, and absent capsule enhancement were identified as independent risk factors for MVI, while age, histologic MVI, alkaline phosphatase, and alanine aminotransferase were independent predictors for recurrence. The nomograms showed high accuracy in predicting MVI and stratifying RFS.