Objective: To develop and validate clinical and radiomics models based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI of dual-phenotype hepatocellular carcinoma (DPHCC) for preoperative differential diagnosis. Methods: Two hundred and fifty inpatients of hepatocellular carcinoma (HCC) confirmed by postoperative pathology, who underwent Gd-EOB-DTPA-enhanced MRI were retrospectively included. A total of 172 inpatients (72 DPHCC and 100 non-DPHCC) were included in Institution 1 (the First Affiliated Hospital of Soochow University) as a training cohort (between January 2020 and July 2023) and 78 inpatients (44 DPHCC and 34 non-DPHCC) were included in Institution 2 (the Third People's Hospital of Nantong) as an external validation cohort(between January 2019 and July 2023). The regions of interest of the tumor were delineated layer by layer in noncontrast phase, arterial phase (AP), portal venous phase (PP) and hepatobiliary phase (HBP) images. The software of FAE was used to extract the radiomics features of the images. Pearson correlation analysis and recursive feature elimination were used for feature selection. Each phase and combined radiomics models were established using logistic regression, linear discriminant analysis and support vector machine. Receiver operating characteristic curve and the areas under the curve (AUC) were used to evaluate and select the dominant radiomics model. The dominant radiomics model was combined with clinically independent predictors to construct a clinical radiomics model. Delong test was used to compare the performance of the models. Results: The age of the training cohort was (59.6±10.4) years, in which there were 135 men (78.5%). In the external validation cohort, the age was (57.8±9.2) years, including 56 men (71.8%). The maximum diameters of the lesions [M (Q1, Q3), 4.7 (2.6, 7.5) vs 2.7 (1.8, 4.4) cm, P<0.001] and the proportion of the multiple lesions (39.5% vs 16.7%, P<0.001) in the training cohort were higher than those in the external validation cohort. In the training group, the proportion of patients with hepatitis B virus (HBV) infection in the DPHCC subgroup (66.7%,48/172) was higher than that in non-DPHCC subgroup (49.0%,49/78,P=0.021). In the external validation cohort, the AUC (95%CI) of the PP [0.835 (0.733-0.937)] and combined radiomics models [0.786 (0.681-0.891)] were significantly higher than that of noncontrast phase [0.451 (0.319-0.584)], AP [0.566 (0.435-0.696)] and HBP models [0.496 (0.363-0.629)] (all P<0.05). There was no significant difference in AUC between PP radiomics model and combined radiomics model (P=0.189). The AUC between the radiomics models and clinical-radiomics models, which were brought into clinically independent variable HBV, showed no significant difference (all P>0.05). Conclusion: Gd-EOB-DTPA-enhanced MRI radiomics model based on portal venous phase may be available for discriminating DPHCC from non-DPHCC before operation.
目的： 建立和验证基于钆塞酸二钠（Gd-EOB-DTPA）增强MRI的双表型肝细胞癌（DPHCC）术前诊断影像组学模型。 方法： 回顾性收集行Gd-EOB-DTPA增强MRI检查并经术后病理证实为肝细胞癌（HCC）的住院患者共250例，其中苏州大学附属第一医院的172例患者（DPHCC 72例，非DPHCC 100例）作为训练组（2020年1月至2023年7月），南通市第三人民医院的78例患者（DPHCC 44例，非DPHCC 34例）作为外部验证组（2019年1月至2023年7月）。于平扫、动脉期（AP）、门静脉期（PP）和肝胆期（HBP）图像中逐层勾画肿瘤感兴趣区，使用开源软件FAE进行影像组学特征提取，应用Pearson相关性分析及递归特征消除法进行特征选择，使用逻辑回归、线性判别分析、支持向量机3种分类器构建各期及联合影像组学DPHCC术前诊断影像组学模型。采用受试者工作特征曲线下面积（AUC）评估并筛选最优影像组学模型。联合诊断效能最优的组学模型与临床独立因素构建临床影像组学模型。采用Delong检验评价模型AUC的差异。 结果： 训练组年龄为（59.6±10.4）岁，男135例（78.5%），外部验证组年龄为（57.8±9.2）岁，男56例（71.8%）。训练组病灶最大径［M（Q1，Q3），4.7（2.6，7.5）比2.7（1.8，4.4）cm］及多发病灶比例（39.5%比16.7%）均高于外部验证组（均P<0.001）。在训练组中，DPHCC亚组患者乙型肝炎病毒（HBV）感染率（66.7%，48/172）高于非DPHCC亚组（49.0%，49/78）（P=0.021）；在外部验证组中，影像组学模型中PP模型和三期联合模型AUC（95%CI）分别为0.835（0.733~0.937）和0.786（0.681~0.891），均高于平扫的0.451（0.319~0.584）、AP的0.566（0.435~0.696）和HBP模型的0.496（0.363~0.629）（均P<0.05），PP模型与三期联合模型AUC差异无统计学意义（P=0.189）；影像组学模型与纳入HBV感染后的临床-影像组学模型的AUC差异亦无统计学意义（均P>0.05）。 结论： Gd-EOB-DTPA增强MRI PP影像组学模型可用于术前鉴别DPHCC和非DPHCC。.