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A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs).

Methods

A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies.

Results

Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed.

Conclusion

The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

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Abbreviations

FLLs:

Focal liver lesions

CECT:

Contrast-enhanced computed tomography

US:

Ultrasound

CT:

Contrast-enhanced computed tomography

MRI:

Magnetic resonance imaging

HCC:

Hepatocellular carcinoma

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

FNH:

Focal nodular hyperplasia

DN:

Dysplastic nodule

DCA:

Decision curve analysis

AUC:

Area under the curve

MLP:

Multilayer perceptron

ROC:

Receiver operating characteristic

ROIs:

Region of interests

CV:

Cross-validation

MSE:

Mean square error

AFP:

Alpha fetoprotein

BMI:

Body mass index

APHE:

Arterial phase high enhanced

w-HCC:

Well-differentiated hepatocellular carcinoma

BMUS:

B-mode ultrasound

SWE:

Shear wave elastography

SWV:

Shear wave viscosity

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Funding

This work was supported by Grants 82172027 from the National Scientific Foundation Committee of China.

Author information

Author notes

  1. Xiaoling Yu and Ping Liang are contributed equally to this work as co-corresponding authors.

  2. Zhen Wang and Jundong Yao are contributed equally to this work.

Authors and Affiliations

  1. Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China

    Zhen Wang & Lu Li

  2. Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China

    Zhen Wang, Jundong Yao, Fangyi Liu, Jie Yu, Shuo Wang, YiQiong Zhang, Lu Li, Xiaocong Dong & Xiaoling Yu

  3. Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China

    Xiang Jing

  4. Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Kaiyan Li

  5. Department of Hepatobiliary Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China

    ShiChun Lu

  6. Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China

    Hong Yang

  7. Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China

    Hong Ding

  8. Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Kai Li

  9. Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, China

    Wen Cheng

  10. Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, Guangming District, Shenzhen, China

    Guangzhi He

  11. Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Tianan Jiang

  12. Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China

    Zhiyu Han, Zhigang Cheng, Shuilian Tan, Zhen Wang, Erpeng Qi & Ping Liang

  13. Department of Ultrasound, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, China

    Jundong Yao

Authors
  1. Zhen Wang
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Contributions

Ping Liang, Xiaoling Yu, Zhen Wang, and Jundong Yao contributed to concept and design. All authors contributed to experiments and procedures. Zhen Wang and Jundong Yao contributed to writing of article. Zhen Wang and Shuo Wang contributed to statistical analysis. Xiaoling Yu contributed to supervision and is the graduate mentor.

Corresponding authors

Correspondence to Ping Liang or Xiaoling Yu.

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Wang, Z., Yao, J., Jing, X. et al. A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04253-4

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