Interpretable radiomics model based on magnetic resonance imaging to predict responses to transarterial chemoembolization for hepatocellular carcinoma

Table 1 Clinical features of the patients

Clinical parameter	Training group (n = 80)				Validation group (n = 36)				P value
	n	Response group (n = 50)	Nonresponse group (n = 30)	P value	n	Response group (n = 22)	Nonresponse group (n = 14)	P value
Sex				0.609				0.956	0.309
Male	73	45	28		31	19	12
Female	7	5	2		5	3	2
Age				0.954				0.204	0.908
≤ 60	45	28	17		21	11	10
> 60	35	22	13		15	11	4
Number of tumors				0.005				0.221	0.502
≤ 1	32	26	6		20	14	6
> 1	48	24	24		16	8	8
Maximum tumor diameter				0.003				0.005	0.212
≤ 8.62	44	34	10		23	18	5
> 8.62	36	16	20		13	4	9
ALBI				0.729				0.878	0.18
1	38	26	12		20	12	8
2	41	23	18		16	10	6
3	1	1	0		0	0
CTP				0.248				0.927	0.257
A	64	42	22		28	17	11
B	16	8	8		8	5	3
Liver cirrhosis				0.383				0.342	0.074
Yes	35	30	15		17	13	6
No	45	20	15		19	9	8
Portal vein tumor thrombus				0.023				0.311	0.629
Yes	14	45	21		14	12	10
No	66	5	9		22	10	4
NLR				0.862				0.4	1
≤ 3.375	39	24	15		16	11	5
< 3.375	41	26	15		20	11	9
PLR				0.602				0.311	0.4
≤ 114.385	37	22	15		22	12	10
> 114.385	43	28	15		14	10	4
ALT (U/L)				0.129				0.592	0.517
≤ 50	46	32	14		25	16	9
> 50	34	18	16		11	6	5
ALB (g/L)				0.729				0.878	1
≤ 40	42	27	15		20	12	8
> 40	38	23	15		16	10	6
AST (U/L)				0.313				0.927	0.571
≤ 40	24	17	7		8	5	3
> 40	56	33	23		28	17	11
AFP (ng/mL)				0.948				0.629	0.93
< 20	28	18	10		9	6	3
20-400	25	15	10		10	7	3
> 400	27	17	10		17	9	8

ALBI: Albumin-bilirubin; CTP: Child-Turcotte-Pugh; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; ALT: Alanine aminotransferase; ALB: Albumin; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein.

Table 2 Univariate and multivariate logistic regression analyses of the clinical features associated with transarterial chemoembolization treatment response

Clinical feature	Univariate logistic regression analysis		Multivariate logistic regression analysis
	P value	OR (95%CI)	P value	OR (95%CI)
Sex	0.612	0.643 (0.117-3.541)
Age	0.954	0.973 (0.391-2.425)
Number of tumors	0.006	4.333 (1.512-12.416)	0.001	8.067 (2.276-28.594)
Maximum tumor diameter	0.003	4.250 (1.621-11.144)	0.001	7.637 (2.358-24.733)
Liver cirrhosis	0.384	1.500 (0.602-3.735)
Portal vein tumor thrombus	0.029	0.259 (0.077-0.869)
ALBI	0.409	1.443 (0.604-3.443)
CTP	0.252	1.909 (0.631-5.778)
NLR	0.862	0.923 (0.373-2.283)
PLR	0.603	0.786 (0.317-1.948)
ALT	0.131	2.032 (0.890-5.103)
ALB	0.729	1.174 (0.474-2.906)
AST	0.316	1.693 (0.605-4.735)
AFP	0.917	1.030 (0.596-1.777)

ALBI: Albumin-bilirubin; CTP: Child-Turcotte-Pugh; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; ALT: Alanine aminotransferase; ALB: Albumin; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein; OR: Odds ratio; CI: Confidence interval.

Table 3 Radiomic features for predicting transarterial chemoembolization treatment response in hepatocellular carcinoma patients by least absolute shrinkage and selection operator regression analysis

Cohort	Feature type	Feature name
FS-T2WI	Shape feature	Elongation
	GLSZM	Low-gray level zone emphasis
	GLDM	Gray level variance
Arterial phase	GLCM	Inverse variance
	First-order feature	Mean
Portal vein phase	First-order feature	Mean

FS-T2WI: Fat-saturation T2-weighted imaging; GLSZM: Gray level size zone matrix; GLDM: Gray level dependence matrix; GLCM: Gray level co-occurrence matrix.

Table 4 Predictive performance of each model

Cohort	Model	AUC	Sensitivity	Specificity	PPV	NPV	ACC	F1-score
Training	FS-T2WI	0.771	0.367	0.880	0.647	0.698	0.687	0.468
	AP	0.668	0.300	0.940	0.750	0.691	0.700	0.429
	PVP	0.725	0.233	0.940	0.700	0.671	0.675	0.350
	JR	0.845	0.600	0.940	0.857	0.797	0.813	0.706
	RC	0.929	0.833	0.920	0.862	0.902	0.888	0.847
Validation	FS-T2WI	0.705	0.429	0.772	0.545	0.680	0.639	0.480
	AP	0.666	0.357	0.864	0.625	0.679	0.667	0.455
	PVP	0.675	0.286	0.955	0.800	0.677	0.694	0.421
	JR	0.799	0.643	0.864	0.750	0.792	0.778	0.692
	RC	0.815	0.500	0.909	0.778	0.741	0.750	0.609

FS-T2WI: Fat-saturation T2-weighted imaging; AP: Arterial phase; PVP: Portal venous phase; JR: Joint-radiomic; RC: Radiomic-clinical; AUC: Area under the curve; PPV: Positive predictive value; NPV: Negative predictive value; ACC: Accuracy.