Preoperative prediction of HCC microvascular invasion by multimodel peritumoral diffusion MRI.
6 affiliations
- 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. [email protected].
- 2Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China. [email protected].
- 3Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
- 4Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
- 5Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. [email protected].
- 6Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China. [email protected].
Abstract
Objective
Most studies emphasize intratumoral diffusion-weighted imaging (DWI) metrics, but few studies have examined whether peritumoral DWI metrics can provide added value. We aimed to evaluate three-dimensional, multiscale, multimodel DWI parameters within intratumoral and peritumoral volumes of interest for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC).Materials and methods
Seventy patients with HCC, including 42 with MVI, were prospectively enrolled. We calculated parameters from monoexponential, intravoxel incoherent motion, diffusion kurtosis imaging (DKI), stretched-exponential model (SEM), and continuous-time random-walk models within the tumor and in 3-mm (P3) and 5-mm (P5) peritumoral rims. Features showing differences on univariable analysis were further screened using logistic regression with variance inflation factor filtering to build combined models. Diagnostic performance was assessed by areas under the receiver operating characteristic curve (AUROC).Results
Four intratumoral diffusion-coefficient-related metrics showed significant differences between groups. In the peritumoral regions, 12 parameters differed between groups, including diffusion-coefficient-related indices and heterogeneity-related metrics. Among single parameters, P3_DKI_Kapp achieved the best discrimination for MVI (AUROC = 0.713); P5_DKI_Kapp and Tumor_SEM_DDC were selected as independent imaging predictors. After integrating alpha-fetoprotein (AFP) and tumor size, the combined model (Cli-IntraPeriDWI) yielded the best performance (AUROC = 0.844). SHAP analysis indicated that higher AFP, larger tumor size, higher P5_DKI_Kapp, and lower Tumor_SEM_DDC were associated with increased MVI risk.Conclusion
Peritumoral DWI offers multiple biomarkers and outperforms intratumoral metrics for MVI prediction. An interpretable model integrating peritumoral and intratumoral DWI with clinical factors enables accurate, noninvasive preoperative MVI risk stratification in HCC.Key points
Question Can multiscale, multimodel peritumoral DWI metrics improve preoperative prediction of MVI in HCC compared with intratumoral DWI metrics? Findings Compared with intratumoral DWI, peritumoral DWI offered more potential imaging biomarkers and superior diagnostic capability for the preoperative diagnosis of MVI in HCC. Relevance statement By integrating intratumoral and peritumoral metrics with clinical risk factors, we developed a model achieving optimal performance and transparent decision interpretability for MVI assessment, supporting preoperative prognostic evaluation and individualized treatment planning in HCC.
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BibTeX
@article{zhang2026preoperative,
title = {{Preoperative prediction of HCC microvascular invasion by multimodel peritumoral diffusion MRI.}},
author = {Yunfei Zhang and Jiejun Chen and Xianling Qian and Mengsu Zeng},
journal = {European radiology experimental},
year = {2026},
month = oct,
doi = {10.1186/s41747-026-00817-9},
url = {https://europepmc.org/article/MED/42909743},
note = {CC BY},
}
RIS
TY - JOUR
TI - Preoperative prediction of HCC microvascular invasion by multimodel peritumoral diffusion MRI.
AU - Yunfei Zhang
AU - Jiejun Chen
AU - Xianling Qian
AU - Mengsu Zeng
PY - 2026
DA - 2026/10/23
JO - European radiology experimental
DO - 10.1186/s41747-026-00817-9
UR - https://europepmc.org/article/MED/42909743
AB - Objective Most studies emphasize intratumoral diffusion-weighted imaging (DWI) metrics, but few studies have examined whether peritumoral DWI metrics can provide added value. We aimed to evaluate three-dimensional, multiscale, multimodel DWI parameters within intratumoral and peritumoral volumes of interest for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC).Materials and methods Seventy patients with HCC, including 42 with MVI, were prospectively enrolled. We calculated parameters from monoexponential, intravoxel incoherent motion, diffusion kurtosis imaging (DKI), stretched-exponential model (SEM), and continuous-time random-walk models within the tumor and in 3-mm (P3) and 5-mm (P5) peritumoral rims. Features showing differences on univariable analysis were further screened using logistic regression with variance inflation factor filtering to build combined models. Diagnostic performance was assessed by areas under the receiver operating characteristic curve (AUROC).Results Four intratumoral diffusion-coefficient-related metrics showed significant differences between groups. In the peritumoral regions, 12 parameters differed between groups, including diffusion-coefficient-related indices and heterogeneity-related metrics. Among single parameters, P3_DKI_Kapp achieved the best discrimination for MVI (AUROC = 0.713); P5_DKI_Kapp and Tumor_SEM_DDC were selected as independent imaging predictors. After integrating alpha-fetoprotein (AFP) and tumor size, the combined model (Cli-IntraPeriDWI) yielded the best performance (AUROC = 0.844). SHAP analysis indicated that higher AFP, larger tumor size, higher P5_DKI_Kapp, and lower Tumor_SEM_DDC were associated with increased MVI risk.Conclusion Peritumoral DWI offers multiple biomarkers and outperforms intratumoral metrics for MVI prediction. An interpretable model integrating peritumoral and intratumoral DWI with clinical factors enables accurate, noninvasive preoperative MVI risk stratification in HCC.Key points Question Can multiscale, multimodel peritumoral DWI metrics improve preoperative prediction of MVI in HCC compared with intratumoral DWI metrics? Findings Compared with intratumoral DWI, peritumoral DWI offered more potential imaging biomarkers and superior diagnostic capability for the preoperative diagnosis of MVI in HCC. Relevance statement By integrating intratumoral and peritumoral metrics with clinical risk factors, we developed a model achieving optimal performance and transparent decision interpretability for MVI assessment, supporting preoperative prognostic evaluation and individualized treatment planning in HCC.
SN - 2509-9280
ER -