Abstract：
Portal vein infiltration (PVI) is a typical complication of HCC. Once diagnosed, it leads to classification as BCLC C with an enormous impact on patient management, as systemic therapies are henceforth recommended. Our aim was to investigate whether radiomics analysis using imaging at initial diagnosis can predict the occurrence of PVI in the course of disease. Between 2008 and 2018, we retrospectively identified 44 patients with HCC and an in-house, multiphase CT scan at initial diagnosis who presented without CT-detectable PVI but developed it in the course of disease. Accounting for size and number of lesions, growth type, arterial enhancement pattern, Child-Pugh stage, AFP levels, and subsequent therapy, we matched 44 patients with HCC who did not develop PVI to those developing PVI in the course of disease (follow-up ended December 2021). After segmentation of the tumor at initial diagnosis and texture analysis, we used LASSO regression to find radiomics features suitable for PVI detection in this matched set. Using an 80:20 split between training and holdout validation dataset, 17 radiomics features remained in the fitted model. Applying the model to the holdout validation dataset, sensitivity to detect occurrence of PVI was 0.78 and specificity was 0.78. Radiomics feature extraction had the ability to detect aggressive HCC morphology likely to result in future PVI. An additional radiomics evaluation at initial diagnosis might be a useful tool to identify patients with HCC at risk for PVI during follow-up benefiting from a closer surveillance.
摘要：
门静脉浸润(PVI)是肝癌的典型并发症。一旦确诊,它导致分类为BCLCC，对患者管理产生巨大影响，因为今后建议进行全身治疗。我们的目的是研究在初始诊断时使用影像学进行的影像组学分析是否可以预测疾病过程中PVI的发生。在2008年至2018年之间，我们回顾性地确定了44例HCC患者，最初诊断时的多相CT扫描没有CT检测到的PVI，但在疾病过程中发展。考虑到病变的大小和数量，生长类型,动脉增强模式,Child-Pugh阶段,AFP水平,和随后的治疗，我们将44例未发生PVI的HCC患者与在病程中发生PVI的患者进行了匹配(2021年12月结束的随访).在初始诊断和纹理分析时对肿瘤进行分割后，我们使用LASSO回归在该匹配集中寻找适合PVI检测的影像组学特征.在训练和保持验证数据集之间使用80:20的分割，17个影像组学特征保留在拟合模型中。将模型应用于保持验证数据集，检测PVI发生的敏感性为0.78，特异性为0.78。影像组学特征提取具有检测可能导致未来PVI的侵袭性HCC形态的能力。在初始诊断的额外的影像组学评估可能是一个有用的工具，以确定在随访期间有PVI风险的HCC患者，受益于更密切的监测。
