18 F-FDG PET/CT-based radiomics nomogram for preoperative prediction of macrotrabecular-massive hepatocellular carcinoma: a two-center study

Purpose To explore the potential of β-2-[18F] fluoro-2-deoxy- d -glucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) in the evaluation of macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC) and to apply radiomics approach to build a radiomics nomogram for predicting MTM-HCC. Methods This study included 140 (training cohort:101; validation cohort:39) HCC patients who underwent preoperative 18 F-FDG PET/CT at two institutions. The clinical features and tumor FDG metabolism measured by the tumor-to-liver ratio (TLR) via 18 F-FDG PET/CT were retrospectively collected. Radiomics features were extracted from 18 F-FDG PET/CT images and a radiomics score (Rad-score) was calculated. A radiomics nomogram was then constructed by combining Rad-score and independent clinical features and was assessed with a calibration curve. The performance of the radiomics nomogram, Rad-score and TLR was evaluated by receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Results A total of six top weighted radiomics features were selected from PET/CT images by the least absolute shrinkage and selection operator (LASSO) regression algorithm and were used to construct a Rad-score. Multivariate analysis identified Rad-score (OR = 2.183, P = 0.004), age ≤ 50 years (OR = 3.136, P = 0.036), AST > 40U/L (OR = 0.270, P = 0.017) and TLR (OR = 1.641, P = 0.049) as independent predictors of MTM-HCC. The radiomics nomogram had a higher area under the curves (AUCs) than the Rad-score and TLR for predicting MTM-HCC in both training (0.849 [95% CI 0.774–0.924] vs. 0.764 [95% CI 0.669–0.843], 0.763 [95% CI 0.668–0.842]) and validation (0.749 [95% CI 0.584–0.873] vs. 0.690 [95% CI 0.522–0.828], 0.541 [95% CI 0.374–0.701]) cohorts. DCA showed the radiomics nomogram to be more clinically useful than Rad-score and TLR. Conclusions Tumor FDG metabolism is significantly associated with MTM-HCC. A 18 F-FDG PET/CT-based radiomics nomogram may be useful for preoperatively predicting the MTM subtype in primary HCC patients, contributing to pretreatment decision-making.