Chemoembolization for Hepatocellular Carcinoma Including Contrast Agent-Enhanced CT: Response Assessment Model on Radiomics and Artificial Intelligence

Purpose: The aim of this study was to assess the efficacy of an artificial intelligence (AI) algorithm that uses radiomics data to assess recurrence and predict survival in hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Methods: A total of 57 patients with treatment-naïve HCC or recurrent HCC who were eligible for TACE were prospectively enrolled in this study as test data. A total of 100 patients with treatment-naïve HCC or recurrent HCC who were eligible for TACE were retrospectively acquired for training data. Radiomic features were extracted from contrast-enhanced, liver computed tomography (CT) scans obtained before and after TACE. An AI algorithm was trained using the retrospective data and validated using the prospective test data to assess treatment outcomes. Results: This study evaluated 107 radiomic features and 5 clinical characteristics as potential predictors of progression-free survival and overall survival. The C-index was 0.582 as the graph of the cumulative hazard function, predicted by the variable configuration by using 112 radiomics features. The time-dependent AUROC was 0.6 ± 0.06 (mean ± SD). Among the selected radiomics features and clinical characteristics, baseline_glszm_SizeZoneNonUniformity, baseline_ glszm_ZoneVariance and tumor size had excellent performance as predictors of HCC response to TACE with AUROC of 0.853, 0.814 and 0.827, respectively. Conclusions: A radiomics-based AI model is capable of evaluating treatment outcomes for HCC treated with TACE.