Dynamic changes of radiological and radiomics patterns based on MRI in viable hepatocellular carcinoma after transarterial chemoembolization

This study aims to analyze the magnetic resonance imaging (MRI) change patterns of viable hepatocellular carcinomas (HCCs) following the initial transarterial chemoembolization (TACE).

A retrospective analysis of HCC patients’ initial TACE from February 2015 to October 2022 across three centers and a clinical trial (NCT03113955) was conducted. The viability of residual HCCs at one and six months after TACE was evaluated using the LI-RADS Treatment Response Algorithm (LR-TRA) v2024. The radiological and radiomics features of post-TACE viable tumors between baseline and one-month, and between one- and six- months were compared using Wilcoxon signed-rank test and McNemar’s test.

A total of 160 viable tumors were included in the study. Viable tumors at one month after TACE exhibited higher T1WI intensity (P =.024), lower T2WI intensity (P =.005), fewer washout features (P <.001), smaller size (P <.001), and higher ADC values (P <.001) compared to baseline HCC imaging.A significant reduction in DWI intensity (P =.002) and ADC values (P <.001) were observed in viable tumors at one month compared to those at six months. There were 82 (45.1%) radiomics features that changed significantly between the baseline and one-month. Only three radiomics features showed statistically significant difference of viable tumors between one- and six-month.

Compared to the baseline, viable HCCs after TACE demonstrated significant changes of imaging characteristics in a series of radiological and radiomics features at one- and six-month follow-ups.

Clinically diagnosing of viable HCCs using radiological methods is challenging. A comprehensive analysis of these imaging characteristics can facilitate the accurate identification of viable tumors.