Deep learning 3D super-resolution radiomics model based on Gd-enhanced MRI for improving preoperative prediction of HCC pathological grading.

[PURPOSE] The histological grade of hepatocellular carcinoma (HCC) is an important factor associated with early tumor recurrence and prognosis after surgery. Developing a valuable tool to assess this grade is essential for treatment. This study aimed to evaluate the feasibility and efficacy of a deep learning-based three-dimensional super-resolution (SR) magnetic resonance imaging radiomics model for predicting the pathological grade of HCC.

[METHODS] A total of 197 HCC patients were included and divided into a training cohort (n = 157) and a testing cohort (n = 40). Three-dimensional SR technology based on deep learning was used to obtain SR hepatobiliary phase (HBP) images from normal-resolution (NR) HBP images. High-dimensional quantitative features were extracted from manually segmented volumes of interest in NRHBP and SRHBP images. The gradient boosting, light gradient boosting machine, and support vector machine were used to develop three-class (well-differentiated vs. moderately differentiated vs. poorly differentiated) and binary radiomics (well-differentiated vs. moderately and poorly differentiated) models, and the predictive performance of these models was evaluated using several measures.

[RESULTS] All the three-class models using SRHBP images had higher area under the curve (AUC) values than those using NRHBP images. The binary classification models developed with SRHBP images also outperformed those with NRHBP images in distinguishing moderately and poorly differentiated HCC from well-differentiated HCC (AUC = 0.849, sensitivity = 77.8%, specificity = 76.9%, accuracy = 77.5% vs. AUC = 0.603, sensitivity = 48.1%, specificity = 76.9%, accuracy = 57.5%; p = 0.039). Decision curve analysis revealed the clinical value of the models.

[CONCLUSIONS] Deep learning-based three-dimensional SR technology may improve the performance of radiomics models using HBP images for predicting the preoperative pathological grade of HCC.