Comparison of MRI-based response criteria and radiomics for the prediction of early response to transarterial radioembolization in patients with hepatocellular carcinoma

Imaging in France: 2024 Update

Radiology in France has made major advances in recent years through innovations in research and clinical practice. French institutions have developed innovative imaging techniques and artificial intelligence applications in the field of diagnostic imaging and interventional radiology. These include, but are not limited to, a more precise diagnosis of cancer and other diseases, research in dual-energy and photon-counting computed tomography, new applications of artificial intelligence, and advanced treatments in the field of interventional radiology. This article aims to explore the major research initiatives and technological advances that are shaping the landscape of radiology in France. By highlighting key contributions in diagnostic imaging, artificial intelligence, and interventional radiology, we provide a comprehensive overview of how these innovations are improving patient outcomes, enhancing diagnostic accuracy, and expanding the possibilities for minimally invasive therapies. As the field continues to evolve, France's position at the forefront of radiological research ensures that these innovations will play a central role in addressing current healthcare challenges and improving patient care on a global scale.

Predicting treatment response and prognosis of immune checkpoint inhibitors-based combination therapy in advanced hepatocellular carcinoma using a longitudinal CT-based radiomics model: a multicenter study

BACKGROUND

Identifying effective predictive strategies to assess the response of immune checkpoint inhibitors (ICIs)-based combination therapy in advanced hepatocellular carcinoma (HCC) is crucial. This study presents a new longitudinal CT-based radiomics model to predict treatment response and prognosis in advanced HCC patients undergoing ICIs-based combination therapy.

METHODS

Longitudinal CT images were collected before and during the treatment for HCC patients across three institutions from January 2019 to April 2022. A total of 1316 radiomic features were extracted from arterial and portal venous phase abdominal CT images for each patient. A model called Longitudinal Whole-liver CT-based Radiomics (LWCTR) was developed to categorize patients into responders or non-responders using radiomic features and clinical information through support vector machine (SVM) classifiers. The area under the curve (AUC) was used as the performance metric and subsequently applied for risk stratification and prognostic assessment. The Shapley Additive explanations (SHAP) method was used to calculate the Shapley value, which explains the contribution of each feature in the SVM model to the prediction.

RESULTS

This study included 395 eligible participants, with a median age of 57 years (IQR 51-66), comprising 344 males and 51 females. The LWCTR model performed well in predicting treatment response, achieving an AUC of 0.883 (95% confidence interval [CI] 0.881-0.888) in the training cohort, 0.876 (0.858-0.895) in the internal validation cohort, and 0.875 (0.860-0.887) in the external test cohort. The Rad-Nomo model, integrating the LWCTR model's prediction score (Rad-score) with the modified Response Evaluation Criteria in Solid Tumors (mRECIST), demonstrated strong prognostic performance. It achieved time-dependent AUC values of 0.902, 0.823, and 0.850 at 1, 2, and 3 years in the internal validation cohort and 0.893, 0.848, and 0.762 at the same intervals in the external test cohort.

CONCLUSION

The proposed LWCTR model performs well in predicting treatment response and prognosis in patients with HCC receiving ICIs-based combination therapy, potentially contributing to personalized and timely treatment decisions.

Multiparametric MRI-based Machine Learning Radiomics for Predicting Treatment Response to Transarterial Chemoembolization Combined with Targeted and Immunotherapy in Unresectable Hepatocellular Carcinoma: A Multicenter Study

RATIONALE AND OBJECTIVES

To develop and validate multiple machine learning predictive models incorporating clinical features and pretreatment multiparametric magnetic resonance imaging (MRI) radiomic features for predicting treatment response to transarterial chemoembolization combined with molecular targeted therapy plus immunotherapy in unresectable hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

This retrospective study involved 276 patients with unresectable HCC who received combination therapy from 4 medical centers. Patients were divided into one training cohort and two independent external validation cohorts. 16 radiomic features from six multiparametric MRI sequences and 2 clinical features were used to build six machine learning models. The models were evaluated using the area under the curve (AUC), decision curve analysis, and incremental predictive value.

RESULTS

Alpha-fetoprotein and neutrophil-to-lymphocyte ratio are clinical independent predictors of treatment response. In the training cohort and two external validation cohorts, the AUCs and 95% confidence intervals for predicting treatment response were respectively 0.782 (0.698-0.857) 0.695 (0.566-0.823), and 0.679 (0.542-0.810) for the clinical model; 0.942 (0.903-0.974), 0.869 (0.761-0.949), and 0.868 (0.769-0.942) for the radiomics model; and 0.956 (0.920-0.984), 0.895 (0.810-0.967), and 0.892 (0.804-0.957) for the combined clinical-radiomics model. In the three cohorts, the incremental predictive value of the radiomics model over the clinical model was 49.2% (P < 0.001), 28.8% (P < 0.001), and 31.5% (P < 0.001).

CONCLUSION

The combined clinical-radiomics model may provide a reliable and non-invasive tool to predict individual treatment responses and guide and improve clinical decision-making in combination therapy of HCC patients.

A cross-sectional survey investigating surgeon perceptions of pre-operative risk prediction models incorporating radiomic features

PURPOSE

Incisional hernias are a significant source of morbidity in the United States that impact quality of life and can cause life-threatening complications. Complex patient factors, collected as structured and unstructured data, contribute to the risk of developing an incisional hernia following abdominal surgery. It is unknown how risk prediction models derived from imaging data, or radiomic features, can enhance pre-operative surgical planning. This study investigates surgeons' perspectives regarding risk prediction models derived from radiomic features and assesses the model's impact on surgeon behavior.

METHODS

An online cross-sectional survey assessing perceptions of a pre-operative risk prediction model was administered to surgeons across the US from April 23, 2024- May 30, 2024. Surgeons' beliefs of the risk model's impact on surgeon behavior and its applicability in the clinical setting were assessed.

RESULTS

A total of 166 completed surveys were analyzed. Mean age was 52.3 (SD 10.1), 71.1% were male, 78.9% were White, and 90.4% were not Hispanic or Latino. The majority of the respondents were general surgeons (58%), colorectal surgeons (14%), thoracic surgeons (12%), and urologists (7%). The mean level of accuracy predicted from radiomic features needed to prompt a change in management was 74.5% (SD 15.1%). The mean at which FPR and FNR were unacceptable was 25.9% (SD 16.9%) and 26.1% (SD 21.7%), respectively. Most believed a risk prediction model tool would improve their peri-operative management.

CONCLUSION

A majority of surgeons were positively supportive of incorporating a hernia risk-prediction clinical decision tool incorporating radiomic features in their clinical practice.

Research progress of MRI-based radiomics in hepatocellular carcinoma

Background

Primary liver cancer (PLC), notably hepatocellular carcinoma (HCC), stands as a formidable global health challenge, ranking as the sixth most prevalent malignant tumor and the third leading cause of cancer-related deaths. HCC presents a daunting clinical landscape characterized by nonspecific early symptoms and late-stage detection, contributing to its poor prognosis. Moreover, the limited efficacy of existing treatments and high recurrence rates post-surgery compound the challenges in managing this disease. While histopathologic examination remains the cornerstone for HCC diagnosis, its utility in guiding preoperative decisions is constrained. Radiomics, an emerging field, harnesses high-throughput imaging data, encompassing shape, texture, and intensity features, alongside clinical parameters, to elucidate disease characteristics through advanced computational techniques such as machine learning and statistical modeling. MRI radiomics specifically holds significant importance in the diagnosis and treatment of hepatocellular carcinoma (HCC).

Objective

This study aims to evaluate the methodology of radiomics and delineate the clinical advancements facilitated by MRI-based radiomics in the realm of hepatocellular carcinoma diagnosis and treatment.

Methods

A systematic review of the literature was conducted, encompassing peer-reviewed articles published between July 2018 and Jan 2025, sourced from PubMed and Google Scholar. Key search terms included Hepatocellular carcinoma, HCC, Liver cancer, Magnetic resonance imaging, MRI, radiomics, deep learning, machine learning, and artificial intelligence.

Results

A comprehensive analysis of 93 articles underscores the efficacy of MRI radiomics, a noninvasive imaging analysis modality, across various facets of HCC management. These encompass tumor differentiation, subtype classification, histopathological grading, prediction of microvascular invasion (MVI), assessment of treatment response, early recurrence prognostication, and metastasis prediction.

Conclusion

MRI radiomics emerges as a promising adjunctive tool for early HCC detection and personalized preoperative decision-making, with the overarching goal of optimizing patient outcomes. Nevertheless, the current lack of interpretability within the field underscores the imperative for continued research and validation efforts.

Artificial intelligence in interventional radiology: Current concepts and future trends

While artificial intelligence (AI) is already well established in diagnostic radiology, it is beginning to make its mark in interventional radiology. AI has the potential to dramatically change the daily practice of interventional radiology at several levels. In the preoperative setting, recent advances in deep learning models, particularly foundation models, enable effective management of multimodality and increased autonomy through their ability to function minimally without supervision. Multimodality is at the heart of patient-tailored management and in interventional radiology, this translates into the development of innovative models for patient selection and outcome prediction. In the perioperative setting, AI is manifesting itself in applications that assist radiologists in image analysis and real-time decision making, thereby improving the efficiency, accuracy, and safety of interventions. In synergy with advances in robotic technologies, AI is laying the groundwork for an increased autonomy. From a research perspective, the development of artificial health data, such as AI-based data augmentation, offers an innovative solution to this central issue and promises to stimulate research in this area. This review aims to provide the medical community with the most important current and future applications of AI in interventional radiology.

Predicting treatment responses using magnetic resonance imaging-based radiomics in hepatocellular carcinoma patients undergoing transarterial radioembolization

OBJECTIVE

This study evaluates the efficacy of magnetic resonance imaging-based radiomics in predicting treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization.

METHODS

Pre-treatment magnetic resonance imaging scans from 65 hepatocellular carcinoma patients were analyzed. Radiomic features were extracted from axial T1-weighted and T2-weighted sequences using a standardized workflow involving image preprocessing, segmentation, and feature extraction. Multivariate logistic regression models combining radiomic and clinical features were developed to predict treatment outcomes. The performance of the models was evaluated using the area under the curve metric.

RESULTS

The study included 65 patients with a median age of 64 years; 44.6% showed a complete response, while 55.4% showed a non-complete response. The median radiomics score in the T1-weighted portal phase was -0.49 for non-complete responders and -0.07 for complete responders (p<0.001). In the T2-weighted sequence, the median radiomics score was -0.76 for non-complete responders and 1.1 for complete responders (p<0.001). Tumor size ≥5 cm was a significant predictor of non-complete response in univariate analysis (p=0.027) but not in multivariate analysis after adding radiomics scores. The area under the curve for the radiomics signature in predicting non-complete response was 0.754 for T1-weighted and 0.850 for T2-weighted sequences.

CONCLUSION

Magnetic resonance imaging-based radiomics enhances the prediction of treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization. Integrating radiomic features with clinical parameters significantly improves predictive accuracy.

Assessment of Y-90 Radioembolization Treatment Response for Hepatocellular Carcinoma Cases Using MRI Radiomics

Objectives

This study aimed to investigate the ability of radiomics features extracted from magnetic resonance imaging (MRI) images to differentiate between responders and non-responders for hepatocellular carcinoma (HCC) cases who received Y-90 transarterial radioembolization treatment.

Methods

Thirty-six cases of HCC who underwent MRI scans after Y-90 radioembolization were included in this study. Tumors were segmented from MRI T2 images, and then 87 radiomic features were extracted through the LIFEx package software. Treatment response was determined 9 months after treatment through the modified response evaluation criteria in solid tumours (mRECIST).

Results

According to mRECIST, 28 cases were responders and 8 cases were non-responders. Two radiomics features, "Grey Level Size Zone Matrix (GLSZM)-Small Zone Emphasis" and "GLSZM-Normalized Zone Size Non-Uniformity", were the radiomics features that could predict treatment response with the area under curve (AUC)= 0.71, sensitivity= 0.93, and specificity= 0.62 for both features. Whereas the other 4 features (kurtosis, intensity histogram root mean square, neighbourhood gray-tone difference matrix strength, and GLSZM normalized grey level non-uniformity) have a relatively lower but acceptable discrimination ability range from AUC= 0.6 to 0.66.

Conclusion

MRI radiomics analysis could be used to assess the treatment response for HCC cases treated with Y-90 radioembolization.

Research progress on machine algorithm prediction of liver cancer prognosis after intervention therapy

The treatment for liver cancer has transitioned from traditional surgical resection to interventional therapies, which have become increasingly popular among patients due to their minimally invasive nature and significant local efficacy. However, with advancements in treatment technologies, accurately assessing patient response and predicting long-term survival has become a crucial research topic. Over the past decade, machine algorithms have made remarkable progress in the medical field, particularly in hepatology and prognosis studies of hepatocellular carcinoma (HCC). Machine algorithms, including deep learning and machine learning, can identify prognostic patterns and trends by analyzing vast amounts of clinical data. Despite significant advancements, several issues remain unresolved in the prognosis prediction of liver cancer using machine algorithms. Key challenges and main controversies include effectively integrating multi-source clinical data to improve prediction accuracy, addressing data privacy and ethical concerns, and enhancing the transparency and interpretability of machine algorithm decision-making processes. This paper aims to systematically review and analyze the current applications and potential of machine algorithms in predicting the prognosis of patients undergoing interventional therapy for liver cancer, providing theoretical and empirical support for future research and clinical practice.

Delta radiomics: an updated systematic review

BACKGROUND

Radiomics can provide quantitative features from medical imaging that can be correlated with various biological features and diverse clinical endpoints. Delta radiomics, on the other hand, consists in the analysis of feature variation at different acquisition time points, usually before and after therapy. The aim of this study was to provide a systematic review of the different delta radiomics approaches.

METHODS

Eligible articles were searched in Embase, Pubmed, and ScienceDirect using a search string that included free text and/or Medical Subject Headings (MeSH) with 3 key search terms: 'radiomics,' 'texture,' and 'delta.' Studies were analyzed using QUADAS-2 and the RQS tool.

RESULTS

Forty-eight studies were finally included. The studies were divided into preclinical/methodological (5 studies, 10.4%); rectal cancer (6 studies, 12.5%); lung cancer (12 studies, 25%); sarcoma (5 studies, 10.4%); prostate cancer (3 studies, 6.3%), head and neck cancer (6 studies, 12.5%); gastrointestinal malignancies excluding rectum (7 studies, 14.6%) and other disease sites (4 studies, 8.3%). The median RQS of all studies was 25% (mean 21% ± 12%), with 13 studies (30.2%) achieving a quality score < 10% and 22 studies (51.2%) < 25%.

CONCLUSIONS

Delta radiomics shows potential benefit for several clinical endpoints in oncology, such asdifferential diagnosis, prognosis and prediction of treatment response, evaluation of side effects. Nevertheless, the studies included in this systematic review suffer from the bias of overall low methodological rigor, so that the conclusions are currently heterogeneous, not robust and hardly replicable. Further research with prospective and multicenter studies is needed for the clinical validation of delta radiomics approaches.

Pretreatment CT-based machine learning radiomics model predicts response in unresectable hepatocellular carcinoma treated with lenvatinib plus PD-1 inhibitors and interventional therapy

BACKGROUND

Lenvatinib plus PD-1 inhibitors and interventional (LPI) therapy have demonstrated promising treatment effects in unresectable hepatocellular carcinoma (HCC). However, biomarkers for predicting the response to LPI therapy remain to be further explored. We aimed to develop a radiomics model to noninvasively predict the efficacy of LPI therapy.

METHODS

Clinical data of patients with HCC receiving LPI therapy were collected in our institution. The clinical model was built with clinical information. Nine machine learning classifiers were tested and the multilayer perceptron classifier with optimal performance was used as the radiomics model. The clinical-radiomics model was constructed by integrating clinical and radiomics scores through logistic regression analysis.

RESULTS

151 patients were enrolled in this study (2:1 randomization, 101 and 50 in the training and validation cohorts), of which three achieved complete response, 69 showed partial response, 46 showed stable disease, and 33 showed progressive disease. The objective response rate, disease control rate, and conversion resection rates were 47.7, 78.1 and 23.2%. 14 features were selected from the initially extracted 1223 for radiomics model construction. The area under the curves of the radiomics model (0.900 for training and 0.893 for validation) were comparable to that of the clinical-radiomics model (0.912 for training and 0.892 for validation), and both were superior to the clinical model (0.669 for training and 0.585 for validation). Meanwhile, the radiomics model can categorize participants into high-risk and low-risk groups for progression-free survival (PFS) and overall survival (OS) in the training (HR 1.913, 95% CI 1.121 to 3.265, p=0.016 for PFS; HR 4.252, 95% CI 2.051 to 8.816, p=0.001 for OS) and validation sets (HR 2.347, 95% CI 1.095 to 5.031, p=0.012 for PFS; HR 2.592, 95% CI 1.050 to 6.394, p=0.019 for OS).

CONCLUSION

The promising machine learning radiomics model was developed and validated to predict the efficacy of LPI therapy for patients with HCC and perform risk stratification, with comparable performance to clinical-radiomics model.

Radiomics Features Extracted From Pre- and Postprocedural Imaging in Early Prediction of Treatment Response in Patients Undergoing Transarterial Radioembolization of Hepatic Lesions: A Systematic Review, Meta-Analysis, and Quality Appraisal Study

INTRODUCTION

Transarterial radioembolization (TARE) is one of the most promising therapeutic options for hepatic masses. Radiomics features, which are quantitative numeric features extracted from medical images, are considered to have potential in predicting treatment response in TARE. This article aims to provide meta-analytic evidence and critically appraise the methodology of radiomics studies published in this regard.

METHODS

A systematic search was performed on PubMed, Scopus, Embase, and Web of Science. All relevant articles were retrieved, and the characteristics of the studies were extracted. The Radiomics Quality Score and Checklist for Evaluation of Radiomics Research were used to assess the methodologic quality of the studies. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve in predicting objective response were determined.

RESULTS

The systematic review included 15 studies. The average Radiomics Quality Score of these studies was 11.4 ± 2.1, and the average Checklist for Evaluation of Radiomics Research score was 33± 6.7. There was a notable correlation (correlation coefficient = 0.73) between the two metrics. Adherence to quality measures differed considerably among the studies and even within different components of the same studies. The pooled sensitivity and specificity of the radiomics models in predicting complete or partial response were 83.5% (95% confidence interval 76%-88.9%) and 86.7% (95% confidence interval 78%-92%), respectively.

CONCLUSION

Radiomics models show great potential in predicting treatment response in TARE of hepatic lesions. However, the heterogeneity seen between the methodologic quality of studies may limit the generalizability of the results. Future initiatives should aim to develop radiomics signatures using multiple external datasets and adhere to quality measures in radiomics methodology.

CT and MRI of abdominal cancers: current trends and perspectives in the era of radiomics and artificial intelligence

Abdominal cancers continue to pose daily challenges to clinicians, radiologists and researchers. These challenges are faced at each stage of abdominal cancer management, including early detection, accurate characterization, precise assessment of tumor spread, preoperative planning when surgery is anticipated, prediction of tumor aggressiveness, response to therapy, and detection of recurrence. Technical advances in medical imaging, often in combination with imaging biomarkers, show great promise in addressing such challenges. Information extracted from imaging datasets owing to the application of radiomics can be used to further improve the diagnostic capabilities of imaging. However, the analysis of the huge amount of data provided by these advances is a difficult task in daily practice. Artificial intelligence has the potential to help radiologists in all these challenges. Notably, the applications of AI in the field of abdominal cancers are expanding and now include diverse approaches for cancer detection, diagnosis and classification, genomics and detection of genetic alterations, analysis of tumor microenvironment, identification of predictive biomarkers and follow-up. However, AI currently has some limitations that need further refinement for implementation in the clinical setting. This review article sums up recent advances in imaging of abdominal cancers in the field of image/data acquisition, tumor detection, tumor characterization, prognosis, and treatment response evaluation.

Current status of magnetic resonance imaging radiomics in hepatocellular carcinoma: A quantitative review with Radiomics Quality Score

BACKGROUND

Radiomics is a promising tool that may increase the value of magnetic resonance imaging (MRI) for different tasks related to the management of patients with hepatocellular carcinoma (HCC). However, its implementation in clinical practice is still far, with many issues related to the methodological quality of radiomic studies.

AIM

To systematically review the current status of MRI radiomic studies concerning HCC using the Radiomics Quality Score (RQS).

METHODS

A systematic literature search of PubMed, Google Scholar, and Web of Science databases was performed to identify original articles focusing on the use of MRI radiomics for HCC management published between 2017 and 2023. The methodological quality of radiomic studies was assessed using the RQS tool. Spearman's correlation (ρ) analysis was performed to explore if RQS was correlated with journal metrics and characteristics of the studies. The level of statistical signi-ficance was set at P < 0.05.

RESULTS

One hundred and twenty-seven articles were included, of which 43 focused on HCC prognosis, 39 on prediction of pathological findings, 16 on prediction of the expression of molecular markers outcomes, 18 had a diagnostic purpose, and 11 had multiple purposes. The mean RQS was 8 ± 6.22, and the corresponding percentage was 24.15% ± 15.25% (ranging from 0.0% to 58.33%). RQS was positively correlated with journal impact factor (IF; ρ = 0.36, P = 2.98 × 10-5), 5-years IF (ρ = 0.33, P = 1.56 × 10-4), number of patients included in the study (ρ = 0.51, P < 9.37 × 10-10) and number of radiomics features extracted in the study (ρ = 0.59, P < 4.59 × 10-13), and time of publication (ρ = -0.23, P < 0.0072).

CONCLUSION

Although MRI radiomics in HCC represents a promising tool to develop adequate personalized treatment as a noninvasive approach in HCC patients, our study revealed that studies in this field still lack the quality required to allow its introduction into clinical practice.

The Role of Artificial Intelligence and Texture Analysis in Interventional Radiological Treatments of Liver Masses: A Narrative Review

Liver lesions, including both benign and malignant tumors, pose significant challenges in interventional radiological treatment planning and prognostication. The emerging field of artificial intelligence (AI) and its integration with texture analysis techniques have shown promising potential in predicting treatment outcomes, enhancing precision, and aiding clinical decision-making. This comprehensive review aims to summarize the current state-of-the-art research on the application of AI and texture analysis in determining treatment response, recurrence rates, and overall survival outcomes for patients undergoing interventional radiological treatment for liver lesions. Furthermore, the review addresses the challenges associated with the implementation of AI and texture analysis in clinical practice, including data acquisition, standardization of imaging protocols, and model validation. Future directions and potential advancements in this field are discussed. Integration of multi-modal imaging data, incorporation of genomics and clinical data, and the development of predictive models with enhanced interpretability are proposed as potential avenues for further research. In conclusion, the application of AI and texture analysis in predicting outcomes of interventional radiological treatment for liver lesions shows great promise in augmenting clinical decision-making and improving patient care. By leveraging these technologies, clinicians can potentially enhance treatment planning, optimize intervention strategies, and ultimately improve patient outcomes in the management of liver lesions.

Neuroendocrine liver metastases treated using transarterial radioembolization: Identification of prognostic parameters at 68Ga-DOTATATE PET/CT

PURPOSE

To identify prognostic clinical and imaging parameters for patients with neuroendocrine liver metastases (NELMs) undergoing transarterial radioembolization (TARE).

MATERIALS AND METHODS

Forty-seven patients (27 men; mean age, 64 years) with NELMs who received TARE, along with pre-procedure liver MRI and 68Ga-DOTATATE positron emission tomography/computed tomography were included. Apparent diffusion coefficient and standardized uptake value (SUV) of three liver metastases, normal spleen and liver were measured. SUVmax or SUVmean were used for the calculation of tumor-to-organ ratios (tumor-to-spleen and tumor-to-liver ratios) using all possible combinations (including SUVmax/SUVmax, SUVmax/SUVmean, and SUVmean/SUVmean). Clinical parameters (hepatic tumor-burden, presence of extra-hepatic metastases, chromograninA, Ki-67 and bilirubin levels) were assessed. Overall survival, progression-free survival (PFS) and hepatic progression-free survival (HPFS) were calculated using Kaplan-Meier curves.

RESULTS

Median overall survival, PFS and HPFS were 49.6, 13.1 and 28.3 months, respectively. In multivariable Cox regression analysis, low Ki-67 (≤ 5%), low hepatic tumor-burden (< 10%), absence of extrahepatic metastases, and increased Tmean/Lmax ratio were significant prognostic factors of longer overall survival and HPFS. High baseline chromograninA (> 1330 ng/mL) was associated with shorter HPFS. Tmean/Lmax > 1.9 yielded a median overall survival of 69 vs. 33 months (P < 0.04), and a median HPFS of 30 vs. 19 months (P = 0.09). For PFS, high baseline SUVmax of NELMs was the single significant parameter in the multivariable model. SUVmax > 28 resulted in a median PFS of 16.9 vs. 6.5 months, respectively (P = 0.001).

CONCLUSION

High preinterventional Tmean/Lmax ratios, and high SUVmax on 68Ga-DOTATATE positron emission tomography/computed tomography seem to have prognostic value in patients with NELMs undergoing TARE, potentially aiding patient selection and management alongside conventional variables.

Imaging in interventional oncology, the better you see, the better you treat

Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up.

Using Machine Learning to Predict Response to Image-guided Therapies for Hepatocellular Carcinoma

Interventional oncology is a rapidly growing field with advances in minimally invasive image-guided local-regional treatments for hepatocellular carcinoma (HCC), including transarterial chemoembolization, transarterial radioembolization, and thermal ablation. However, current standardized clinical staging systems for HCC are limited in their ability to optimize patient selection for treatment as they rely primarily on serum markers and radiologist-defined imaging features. Given the variation in treatment responses, an updated scoring system that includes multidimensional aspects of the disease, including quantitative imaging features, serum markers, and functional biomarkers, is needed to optimally triage patients. With the vast amounts of numerical medical record data and imaging features, researchers have turned to image-based methods, such as radiomics and artificial intelligence (AI), to automatically extract and process multidimensional data from images. The synthesis of these data can provide clinically relevant results to guide personalized treatment plans and optimize resource utilization. Machine learning (ML) is a branch of AI in which a model learns from training data and makes effective predictions by teaching itself. This review article outlines the basics of ML and provides a comprehensive overview of its potential value in the prediction of treatment response in patients with HCC after minimally invasive image-guided therapy.

Radiomic analysis of abdominal organs during sepsis of digestive origin in a French intensive care unit

BACKGROUND

Sepsis is a severe and common cause of admission to the intensive care unit (ICU). Radiomic analysis (RA) may predict organ failure and patient outcomes. The objective of this study was to assess a model of RA and to evaluate its performance in predicting in-ICU mortality and acute kidney injury (AKI) during abdominal sepsis.

METHODS

This single-center, retrospective study included patients admitted to the ICU for abdominal sepsis. To predict in-ICU mortality or AKI, elastic net regularized logistic regression and the random forest algorithm were used in a five-fold cross-validation set repeated 10 times.

RESULTS

Fifty-five patients were included. In-ICU mortality was 25.5%, and 76.4% of patients developed AKI. To predict in-ICU mortality, elastic net and random forest models, respectively, achieved areas under the curve (AUCs) of 0.48 (95% confidence interval [CI], 0.43-0.54) and 0.51 (95% CI, 0.46-0.57) and were not improved combined with Simplified Acute Physiology Score (SAPS) II. To predict AKI with RA, the AUC was 0.71 (95% CI, 0.66-0.77) for elastic net and 0.69 (95% CI, 0.64-0.74) for random forest, and these were improved combined with SAPS II, respectively; AUC of 0.94 (95% CI, 0.91-0.96) and 0.75 (95% CI, 0.70-0.80) for elastic net and random forest, respectively.

CONCLUSIONS

This study suggests that RA has poor predictive performance for in-ICU mortality but good predictive performance for AKI in patients with abdominal sepsis. A secondary validation cohort is needed to confirm these results and the assessed model.

MRI-based radiomics model and nomogram for predicting the outcome of locoregional treatment in patients with hepatocellular carcinoma

BACKGROUND

Prediction of locoregional treatment response is important for further therapeutic strategy in patients with hepatocellular carcinoma. This study aimed to investigate the role of MRI-based radiomics and nomogram for predicting the outcome of locoregional treatment in patients with hepatocellular carcinoma.

METHODS

The initial postoperative MRI after locoregional treatment in 100 patients with hepatocellular carcinoma was retrospectively analysed. The outcome was evaluated according to mRECIST at 6 months. We delineated the tumour volume of interest on arterial phase, portal venous phase and T2WI. The radiomics features were selected by using the independent sample t test or nonparametric Mann‒Whitney U test and the least absolute shrinkage and selection operator. The clinical variables were selected by using univariate analysis and multivariate analysis. The radiomics model and combined model were constructed via multivariate logistic regression analysis. A nomogram was constructed that incorporated the Rad score and selected clinical variables.

RESULTS

Fifty patients had an objective response, and fifty patients had a nonresponse. Nine radiomics features in the arterial phase were selected, but none of the portal venous phase or T2WI radiomics features were predictive of the treatment response. The best radiomics model showed an AUC of 0.833. Two clinical variables (hCRP and therapy method) were selected. The AUC of the combined model was 0.867. There was no significant difference in the AUC between the combined model and the best radiomics model (P = 0.573). Decision curve analysis demonstrated the nomogram has satisfactory predictive value.

CONCLUSIONS

MRI-based radiomics analysis may serve as a promising and noninvasive tool to predict outcome of locoregional treatment in HCC patients, which will facilitate the individualized follow-up and further therapeutic strategies guidance.

Association of Multi-Phasic MR-Based Radiomic and Dosimetric Features with Treatment Response in Unresectable Hepatocellular Carcinoma Patients following Novel Sequential TACE-SBRT-Immunotherapy

This study aims to investigate the association of pre-treatment multi-phasic MR-based radiomics and dosimetric features with treatment response to a novel sequential trans-arterial chemoembolization (TACE) plus stereotactic body radiotherapy (SBRT) plus immunotherapy regimen in unresectable Hepatocellular Carcinoma (HCC) sub-population. Twenty-six patients with unresectable HCC were retrospectively analyzed. Radiomic features were extracted from 42 lesions on arterial phase (AP) and portal-venous phase (PVP) MR images. Delta-phase (DeltaP) radiomic features were calculated as AP-to-PVP ratio. Dosimetric data of the tumor was extracted from dose-volume-histograms. A two-sided independent Mann-Whitney U test was used to assess the clinical association of each feature, and the classification performance of each significant independent feature was assessed using logistic regression. For the 3-month timepoint, four DeltaP-derived radiomics that characterize the temporal change in intratumoral randomness and uniformity were the only contributors to the treatment response association (p-value = 0.038-0.063, AUC = 0.690-0.766). For the 6-month timepoint, DeltaP-derived radiomic features (n = 4) maintained strong clinical associations with the treatment response (p-value = 0.047-0.070, AUC = 0.699-0.788), additional AP-derived radiomic features (n = 4) that reflect baseline tumoral arterial-enhanced signal pattern and tumor morphology (n = 1) that denotes initial tumor burden were shown to have strong associations with treatment response (p-value = 0.028-0.074, AUC = 0.719-0.773). This pilot study successfully demonstrated associations of pre-treatment multi-phasic MR-based radiomics with tumor response to the novel treatment regimen.

Prediction of Response of Hepatocellular Carcinoma to Radioembolization: Machine Learning Using Preprocedural Clinical Factors and MR Imaging Radiomics

PURPOSE

To create and evaluate the ability of machine learning-based models with clinicoradiomic features to predict radiologic response after transarterial radioembolization (TARE).

MATERIALS AND METHODS

82 treatment-naïve patients (65 responders and 17 nonresponders; median age: 65 years; interquartile range: 11) who underwent selective TARE were included. Treatment responses were evaluated using the European Association for the Study of the Liver criteria at 3-month follow-up. Laboratory, clinical, and procedural information were collected. Radiomic features were extracted from pretreatment contrast-enhanced T1-weighted magnetic resonance images obtained within 3 months before TARE. Feature selection consisted of intraclass correlation, followed by Pearson correlation analysis and finally, sequential feature selection algorithm. Support vector machine, logistic regression, random forest, and LightGBM models were created with both clinicoradiomic features and clinical features alone. Performance metrics were calculated with a nested 5-fold cross-validation technique. The performances of the models were compared by Wilcoxon signed-rank and Friedman tests.

RESULTS

In total, 1,128 features were extracted. The feature selection process resulted in 12 features (8 radiomic and 4 clinical features) being included in the final analysis. The area under the receiver operating characteristic curve values from the support vector machine, logistic regression, random forest, and LightGBM models were 0.94, 0.94, 0.88, and 0.92 with clinicoradiomic features and 0.82, 0.83, 0.82, and 0.83 with clinical features alone, respectively. All models exhibited significantly higher performances when radiomic features were included (P = .028, .028, .043, and .028, respectively).

CONCLUSIONS

Based on clinical and imaging-based information before treatment, machine learning-based clinicoradiomic models demonstrated potential to predict response to TARE.

Life expectancy of patients with hepatocellular carcinoma according to the upfront treatment: A nationwide analysis

PURPOSE

The purpose of this study was to update the life expectancy of patients with hepatocellular carcinoma (HCC) in an exhaustive nationwide population according to the upfront treatment performed.

MATERIALS AND METHODS

From the French Program for the Medicalization of Information System database, all patients older than 18 years diagnosed with a de novo HCC from January 2011 to December 2018 were retrospectively selected. Five-year survival rates (95% confidence intervals [CI]) were computed according to the first surgical or interventional radiology procedures performed.

RESULTS

A total of 63,996 patients (80% men) with a median age of 68 years (Q₁, Q₃: 61, 77) were selected, including 24,007 patients who underwent at least one procedure (5-year survival of 45.5%; (95% CI: 44.8-46.2), and 39,989 with none (5-year survival, 9.6%; (95% CI: 9.3-10.0). Only 20.5% (13,101/63,996) of patients could undergo an upfront curative procedure. Liver transplantation achieved the best outcome, whether performed upfront (n = 791; 5-year survival, 79.0% [95% CI: 76.1-82.1]) or during subsequent steps (n = 2217; 5-year survival 80.9% [95% CI: 79.2-82.7]). Tumor ablation (n = 5306), open resection (n = 5171), and minimally-invasive resection (n = 1833) achieved 5-year survival rates of 53.8% (95% CI: 52.3-55.4), 54.1% (95% CI: 52.6-55.6), and 66.2% (95% CI: 63.7-68.7), respectively, with more patients with cirrhosis and subsequent procedures in the tumor ablation group. Patients with upfront transarterial (chemo)embolization (n = 10,247) and selective internal radiation therapy (n = 659) had 5-year survival rates of 31.3% (95% CI: 30.3-32.4) and 18.5% (95% CI: 15.2-22.5).

CONCLUSION

While HCC remains mostly diagnosed at an advanced stage associated with a poor prognosis, all the curative options provide 5-year survival rates above 50%.

Radiomics: A radiological evidence-based artificial intelligence technique to facilitate personalized precision medicine in hepatocellular carcinoma

The high postoperative recurrence rates in hepatocellular carcinoma (HCC) remain a major hurdle in its management. Appropriate staging and treatment selection may alleviate the extent of fatal recurrence. However, effective methods to preoperatively evaluate pathophysiologic and molecular characteristics of HCC are lacking. Imaging plays a central role in HCC diagnosis and stratification due to the non-invasive diagnostic criteria. Vast and crucial information is hidden within image data. Other than providing a morphological sketch for lesion diagnosis, imaging could provide new insights to describe the pathophysiological and genetic landscape of HCC. Radiomics aims to facilitate diagnosis and prognosis of HCC using artificial intelligence techniques to harness the immense information contained in medical images. Radiomics produces a set of archetypal and robust imaging features that are correlated to key pathological or molecular biomarkers to preoperatively risk-stratify HCC patients. Inferred with outcome data, comprehensive combination of radiomic, clinical and/or multi-omics data could also improve direct prediction of response to treatment and prognosis. The evolution of radiomics is changing our understanding of personalized precision medicine in HCC management. Herein, we review the key techniques and clinical applications in HCC radiomics and discuss current limitations and future opportunities to improve clinical decision making.

Lung shunt fraction calculations before Y-90 transarterial radioembolization: Comparison of accuracy and clinical significance of planar scintigraphy and SPECT/CT

PURPOSE

To determine the accuracy and clinical significance of planar scintigraphy lung shunt fraction (PLSF) and single-photon emission computerized tomography (SPECT) computed tomography (CT) lung shunt fraction (SLSF) before Y-90 transarterial radioembolization.

MATERIALS AND METHODS

Seventy patients (46 men, 24 women; mean age, 64 ± 9.5 [SD] years) who underwent 83 treatments with Y-90 transarterial radioembolization for primary or secondary malignancies of the liver with a PLSF ≥ 7.5% were retrospectively evaluated. The patients mapping technetium 99 m (Tc-99 m) macroaggregated albumin (MAA) PLSF and SLSF were calculated and compared to the post Y-90 delivery SLSF. A model using modern dose thresholds was created to identify patients who would require dose reduction due to a lung dose ≥ 30 Gy, with patients who required >50% dose reduction considered to be delivery cancelations.

RESULTS

A significant difference was found between mean PLSF (14.7 ± 11.6 [SD]%; range: 7.5-84.1%) and mean SLSF (8.7 ± 8.5 [SD]%; range: 1.7-73.5) (P < 0.001). The mean realized LSF (7.1 ± 3 [SD]%; range:1.5-17.6) was significantly less than the PLSF (P <0.001) but not the SLSF (P = 0.07). PLSF significantly overestimated the realized LSF by more than the SLSF (8.5 ± 5.3 [SD] % [range: -0.1-21.7] vs. 0.8 ± 3.6 [SD] % [range: -5-13.2], respectively) (P < 0.001). Based on the clinical significance model, 20 patients (20/83, 24.1%) would have required dose reduction or cancelation when using PLSF but would not require even a dose reduction when using the SLSF. Significantly more deliveries would have been be canceled if PLSF was used as compared to SLSF (22/83 [26.5%] vs. 6/83 [7.2%], respectively) (P < 0.001).

CONCLUSION

SLSF is significantly more accurate at predicting realized LSF than PLSF and this difference is of clinical significance in a number of patients with a PLSF ≥ 7.5%.

Artificial intelligence: A review of current applications in hepatocellular carcinoma imaging

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and currently the third-leading cause of cancer-related death worldwide. Recently, artificial intelligence (AI) has emerged as an important tool to improve clinical management of HCC, including for diagnosis, prognostication and evaluation of treatment response. Different AI approaches, such as machine learning and deep learning, are both based on the concept of developing prediction algorithms from large amounts of data, or big data. The era of digital medicine has led to a rapidly expanding amount of routinely collected health data which can be leveraged for the development of AI models. Various studies have constructed AI models by using features extracted from ultrasound imaging, computed tomography imaging and magnetic resonance imaging. Most of these models have used convolutional neural networks. These tools have shown promising results for HCC detection, characterization of liver lesions and liver/tumor segmentation. Regarding treatment, studies have outlined a role for AI in evaluation of treatment response and improvement of pre-treatment planning. Several challenges remain to fully integrate AI models in clinical practice. Future research is still needed to robustly evaluate AI algorithms in prospective trials, and improve interpretability, generalizability and transparency. If such challenges can be overcome, AI has the potential to profoundly change the management of patients with HCC. The purpose of this review was to sum up current evidence on AI approaches using imaging for the clinical management of HCC.