Toti L, Argirò R, Angelico R. Habitat imaging before transarterial chemoembolization in hepatocellular carcinoma: Ready for clinical decision-making? World J Gastroenterol 2026; 32(41): 119599 [DOI: 10.3748/wjg.119599]
Corresponding Author of This Article
Luca Toti, MD, PhD, Assistant Professor, HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Viale Oxford, 81, Rome 00133, Italy. toti@med.uniroma2.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 7, 2026; 32(41): 119599 Published online Nov 7, 2026. doi: 10.3748/wjg.119599
Habitat imaging before transarterial chemoembolization in hepatocellular carcinoma: Ready for clinical decision-making?
Luca Toti, Renato Argirò, Roberta Angelico
Luca Toti, Roberta Angelico, HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome 00133, Italy
Renato Argirò, Department of Biomedicine and Prevention, University Hospital of Rome Tor Vergata, Rome 00133, Lazio, Italy
Co-corresponding authors: Luca Toti and Renato Argirò.
Author contributions: Toti L conceived the manuscript, developed the argument, and drafted the review; Argirò R contributed the radiological perspective and critically revised the imaging-related sections; Angelico R contributed the clinical interpretation and critically revised the manuscript; Toti L and Angelico R contributed equally to this manuscript as co-corresponding authors. All authors read and approved the final version.
AI contribution statement: ChatGPT (OpenAI) was used only in a limited supportive manner. In the manuscript text, its use was restricted to minor linguistic and stylistic refinement during revision. For the two schematic figures, ChatGPT was used only to assist visual drafting and graphic arrangement, including the organization of boxes, arrows, icons, and overall layout. The scientific concepts, wording, figure logic, and final content were entirely defined, reviewed, and approved by the authors. No AI tool was used to generate data, analyze results, interpret findings, or make scientific decisions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Luca Toti, MD, PhD, Assistant Professor, HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Viale Oxford, 81, Rome 00133, Italy. toti@med.uniroma2.it
Received: February 14, 2026 Revised: March 1, 2026 Accepted: June 22, 2026 Published online: November 7, 2026 Processing time: 230 Days and 5.9 Hours
Abstract
Transarterial chemoembolization is an important treatment for intermediate-stage hepatocellular carcinoma. However, a significant challenge in daily clinical practice is identifying which patients are most likely to benefit from this treatment. Conventional imaging and standard clinical and radiological variables often do not capture the full biological complexity of these tumors. This is especially true for the intratumoral heterogeneity that can affect both treatment sensitivity and resistance. Habitat imaging offers a different approach to this challenge by partitioning the tumor into spatially distinct subregions that may reflect variations in perfusion, necrosis, cellularity and treatment vulnerability. The recent study suggests that magnetic resonance imaging-based habitat analysis may improve early response prediction when integrated with radiomic and clinical features. At the same time, this potential should be interpreted with caution. Important limitations remain, including protocol dependence, segmentation variability, limited multicentre reproducibility, uncertain biological correlates and the lack of prospective utility studies. In our view, the relevance of habitat imaging lies not only in improving predictive models, but also in its potential to support treatment allocation before therapy, reduce futile transarterial chemoembolization and strengthen multidisciplinary decision-making. This opinion review discusses the biological rationale, the currently available evidence, the main practical barriers and the further steps required before habitat imaging can become a clinically useful tool in hepatocellular carcinoma.
Core Tip: Habitat imaging offers a different way of reading magnetic resonance imaging in hepatocellular carcinoma, moving beyond simple lesion description and trying to capture the tumor’s internal spatial heterogeneity. Its value lies not only in the possibility of predicting response after transarterial chemoembolization, but also in helping clinicians think more carefully about pretreatment selection and multidisciplinary treatment planning. At present, however, this approach is still constrained by important limitations, including methodological fragility, poor standardization, and the lack of solid prospective validation. The key issue is no longer whether habitat imaging is conceptually attractive, but whether it is robust enough to become genuinely useful in clinical practice.
