A Multiphase CT-Based Radiomics-Clinical Model to Identify Inadequate Future Liver Remnant Hypertrophy After Portal...

Area of Science:

• Radiology
• Oncology
• Hepatobiliary Surgery

Background:

• Portal vein embolization (PVE) is crucial for inducing future liver remnant (FLR) hypertrophy before major liver resection.
• Predicting inadequate FLR hypertrophy after PVE is essential for preventing postoperative liver failure.
• Current prediction methods may lack precision, necessitating improved tools for surgical planning.

Purpose of the Study:

• To develop and internally validate a multiphase contrast-enhanced computed tomography (CT) based radiomics-clinical nomogram.
• To predict inadequate future liver remnant (FLR) hypertrophy following portal vein embolization (PVE).
• To guide individualized surgical planning in hepatobiliary surgery.

Main Methods:

• Retrospective enrollment of 98 patients who underwent PVE.
• Extraction of radiomic features from triphasic CT scans and integration with clinical data using a LASSO-reduced Rad-signature and MLP fusion model.
• Evaluation of the nomogram using ROC, calibration, and decision-curve analyses.

Main Results:

• The radiomics-clinical nomogram achieved an AUC of 0.913 (training) and 0.833 (test cohort), outperforming clinical-only models (AUC 0.714).
• Sensitivity and specificity in the test set were 0.824 and 1.000, respectively.
• Pre-PVE FLR, cFLR, serum pre-albumin, prior chemotherapy, hepatitis status, and cirrhosis were independent predictors of adequate hypertrophy.

Conclusions:

• The developed multiphase CECT radiomics-clinical nomogram shows potential for identifying patients at high risk of insufficient FLR hypertrophy post-PVE.
• This internally validated model can support personalized planning in hepatobiliary surgery.
• The nomogram offers a promising tool for improving surgical outcomes in liver surgery patients.