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Radiomics analysis of [18F]FDG PET/CT for microvascular invasion and prognosis prediction in very-early- and early-stage hepatocellular carcinoma

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Abstract

As a reliable preoperative predictor for microvascular invasion (MVI) and disease-free survival (DFS) is lacking, we developed a radiomics nomogram of [18F]FDG PET/CT to predict MVI status and DFS in patients with very-early- and early-stage (BCLC 0, BCLC A) hepatocellular carcinoma (HCC).

Methods

Patients (N = 80) with BCLC0-A HCC who underwent [18F]FDG PET/CT before surgery were enrolled in this retrospective study and were randomized to a training cohort and a validation cohort. Texture features from patients obtained using Lifex software in the training cohort were subjected to LASSO regression to select the most useful predictive features of MVI and DFS. Then, the radiomics nomogram was constructed using the radiomics signature and clinical features and further validated.

Results

To predict MVI, the [18F]FDG PET/CT radiomics signature consisted of five texture features from the PET and six texture features from CT. The signature was significantly associated with MVI status in the training cohort (P = 0.001). None of the clinical features was independent predictors for MVI status (P > 0.05). The area under the curve value of the M-PET/CT model was 0.891 (95% CI: 0.799–0.984) in the training cohort and showed good discrimination and calibration. To predict DFS, the [18F]FDG PET/CT radiomics nomogram (D-PET/CT model) and a clinicopathologic nomogram were built in the training cohort. The D-PET/CT model, which integrated the D-PET/CT radiomics signature with INR and TB, provided better predictive performance (C-index: 0.831, 95% CI: 0.761–0.900) and larger net benefits than the simple clinical model, as determined by decision curve analyses.

Conclusion

The newly developed [18F]FDG PET/CT radiomics signature was an independent biomarker for the estimation of MVI and DFS in patients with very-early- and early-stage HCC. Moreover, PET/CT nomogram, which incorporated the radiomics signature of [18F]FDG PET/CT and clinical risk factors in patients with very-early- and early-stage HCC, performed better for individualized DFS estimation, which might enable a step forward in precise medicine.

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Data availability

All data were transparent. The data used in the current study are available from the corresponding authors on reasonable request.

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Funding

This study was supported financially by the Science and Technology Program of Guangzhou (201604020094) and the Joint Logistic Support Force Project (CWH17J023).

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Author notes

  1. Youcai Li and Yin Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, No. 151, Yanjiang Road, Yuexiu District, Guangzhou, 510000, Guangdong, China

    Youcai Li, Qi Fang, Xiaoyao Zhang, Peng Hou & Xinlu Wang

  2. Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, China

    Yin Zhang & Hubing Wu

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  1. Youcai Li
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Contributions

Conceptualization: Hubing Wu, Xinlu Wang

Methodology: Youcai Li, Yin Zhang

Formal analysis and investigation: Youcai Li, Yin Zhang, Qi Fang, Xiaoyao Zhang, Peng Hou, Hubing Wu, Xinlu Wang

Writing-original draft preparation: Youcai Li, Yin Zhang

Writing-review and editing: Hubing Wu, Xinlu Wang

Funding acquisition: Xinlu Wang

Supervision: Hubing Wu, Xinlu Wang

All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hubing Wu or Xinlu Wang.

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The authors declare that they have no conflict of interest.

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Ethical approval was waived by the local Ethics Committee of Guangzhou Medical University and Southern Medical University in view of the retrospective nature of the study.

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Due to the retrospective nature of the study, informed consent was not obtained in the study.

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The code used in the current study is available from the corresponding authors on reasonable request.

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Li, Y., Zhang, Y., Fang, Q. et al. Radiomics analysis of [18F]FDG PET/CT for microvascular invasion and prognosis prediction in very-early- and early-stage hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 48, 2599–2614 (2021). https://doi.org/10.1007/s00259-020-05119-9

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  • DOI: https://doi.org/10.1007/s00259-020-05119-9

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