Hybrid imaging-clinical model for predicting microvascular invasion in hepatocellular carcinoma using deep learning-derived features from CT.

The role of adipose tissue in predicting microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) remains unclear. This study proposes a method that integrates deep learning and machine learning techniques to investigate the role of adipose tissue in identifying MVI status in HCC patients. We collected enhanced Computed Tomography images from 517 HCC patients across two independent centers, dividing them into a training set, validation set, and test set. The model was constructed using adipose and tumor deep learning features along with clinical features, and the features were input into a classifier for prediction. The model performance was evaluated using the area under the curve(AUC), decision curve analysis, scatter plots, and box plots. Furthermore, we compared the model's performance with that of three radiologists. After incorporating the adipose tissue modality, the venous-phase AUC reached 0.866 (95% CI 0.803-0.920), while the arterial-phase AUC was 0.864 (95% CI 0.792-0.920). The inclusion of the adipose tissue modality provided significant value for clinical diagnosis, which was further validated through visualization analysis. Using predicted labels for grouping, it shows that the overall survival of the high-risk group was significantly lower than that of the low-risk group. Comparative analysis showed that the predictive performance of the model surpassed that of radiologists. Univariate analysis identified the adipose region as a risk factor for predicting MVI status. We developed a hybrid multimodal model that performed comparably to radiologists' assessments. The inclusion of the adipose tissue modality enhanced the accuracy of MVI diagnosis.