CT Radiomics to Predict Regenerative Biomarker Expression after Liver Venous Embolization: Proof-of-Concept in a...

To evaluate regeneration after liver venous embolization in healthy and cirrhotic swine and to assess computed tomography (CT) radiomics for predicting these markers.

Twenty-two pigs with healthy (n = 11) or cirrhotic (n = 11) livers underwent portal vein embolization (PVE) with microspheres and coils, n-butyl cyanoacrylate, combined PVE and hepatic vein embolization (PVE + HVE), or sham control. Four weeks after intervention, future liver remnant (FLR) tissue was analyzed for angiogenesis, proliferation, and epithelial integrity using vascular endothelial growth factor (VEGF), angiopoietin-1, Ki-67, and cytokeratin 8/18/19 immunofluorescence and for apoptosis in the embolized lobe using caspase 3. Spearman correlations were computed between biomarker expression and relative FLR hypertrophy. Biomarkers were dichotomized into high versus low groups based on group-specific means. Logistic regression (LR) and random forest (RF) models were trained on baseline CT radiomics using repeated fivefold cross-validation (100 iterations) to predict biomarker expression. Model performance was assessed by mean area under the curve (AUC), with 95% CIs estimated from the 2.5th and 97.5th percentiles across runs.

All animals completed the study. PVE + HVE resulted in significantly higher expression of VEGF, Ki-67, angiopoietin-1, and caspase 3 than sham controls in both liver conditions (all P < .05). Angiogenesis was greater after PVE + HVE than after PVE in healthy (P < .01) and cirrhotic (P < .001) livers. Ki-67 showed the highest predictive performance (RF AUC, 0.84; LR AUC, 0.81).

Liver venous embolization induces distinct regenerative responses in healthy and cirrhotic swine. Baseline CT radiomics demonstrated moderate discriminative performance for predicting regenerative biomarkers.