MRI肿瘤内与瘤周异质性预测肝细胞癌TACE应答
本研究回顾性纳入156例中晚期肝细胞癌患者，利用治疗前MRI的肿瘤内及瘤周影像生境聚类提取高维影像组学特征，量化肿瘤内与瘤周异质性（ITH/PTH）并构建模型预测TACE客观应答。联合临床-影像模型与ITH/PTH特征的组合模型预测效能最高（AUC 0.899-0.901），提示MRI异质性量化可作为无创生物标志物辅助治疗分层。
要点
- 治疗前MRI的ITH/PTH特征可无创预测肝癌TACE客观应答，组合模型AUC达0.899-0.901。
- 腹水与强化模式是TACE应答的独立预测因素，可构建临床-影像模型。
- 基于无监督聚类的影像生境分析可量化肿瘤内与瘤周异质性。
核心结论
- MRI衍生的肿瘤内与瘤周异质性量化可实现TACE应答的无创治疗前预测，支持个体化治疗分层与临床决策。
研究设计与样本
- 回顾性研究，纳入156例接受TACE的中晚期肝细胞癌患者（男139例，年龄60.52±9.90岁，应答者91例），分为训练集124例与测试集32例。
- 对治疗前MRI的肿瘤及瘤周区域采用无监督聚类划分为不同影像生境，从各生境提取高维影像组学特征并量化生境间特征离散度得到ITH与PTH指标。
- 采用ROC分析、校准曲线、决策曲线分析与混淆矩阵评估模型区分应答者与非应答者的效能，并用Shapley加性解释解读模型决策。
诊断标准与关键数值
- 腹水与强化模式被确定为TACE应答的独立预测因素并构建临床-影像模型（Cli-Rad）。
- 组合模型Cli-Rad-TH预测TACE应答的AUC为0.899-0.901，TH模型AUC为0.822和0.884，Cli-Rad模型AUC为0.663-0.704。
临床应用与阅片要点
- 治疗前可基于MRI提取肿瘤内与瘤周异质性特征，辅助预判TACE客观应答并支持治疗分层。
- 报告中关注腹水与强化模式等独立预测因素，结合异质性模型可提高预测信心。
- 影像生境聚类与特征离散度分析需标准化流程，避免不同分割与聚类参数导致结果不稳。
局限性
- 本研究为回顾性设计。
- 测试集样本量较小（n=32）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: The compromised therapeutic efficacy of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) is closely associated with tumor heterogeneity. Magnetic resonance imaging (MRI)-derived quantification of intratumoral and peritumoral heterogeneity (ITH and PTH) may provide novel, noninvasive biomarkers. To develop and validate an MRI-based strategy leveraging quantitative ITH and PTH for pretreatment identification of patients with HCC achieving objective response to TACE monotherapy.
MATERIALS AND METHODS: This retrospective study included patients with intermediate-stage HCC who underwent TACE. Tumoral and peritumoral regions on pretreatment MRI were partitioned into distinct imaging habitats using unsupervised clustering. High-dimensional radiomic features were extracted from each habitat, and inter-habitat feature dispersion was quantified to yield ITH and PTH metrics. Performance for discriminating responders from non-responders was evaluated using receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis, and confusion matrices. Shapley additive explanations were applied to interpret model decision-making.
RESULTS: A total of 156 patients (139 men; age, 60.52 ± 9.90 years; 91 responders) were included and split into a training cohort (n = 124) and a testing cohort (n = 32). Ten ITH/PTH features were selected to construct the ITH/PTH-driven model (TH). Ascites and enhancement pattern were identified as independent predictors of TACE response and were used to build a clinical-radiological model (Cli-Rad). A combined model integrating Cli-Rad and TH features (Cli-Rad-TH) achieved the highest discrimination for predicting TACE response (area under the receiver operating characteristic curve (AUC) = 0.899-0.901), followed by TH (AUC = 0.822 and 0.884) and Cli-Rad (AUC = 0.663-0.704).
CONCLUSION: MRI-derived quantification of ITH and PTH enables noninvasive pretreatment prediction of TACE response. This strategy may support individualized treatment stratification and improve clinical decision-making.
引用
- Wu F, Huang P, Xiao Y, et al. MRI-Derived Intra- and Peritumoral Heterogeneity for Predicting Response to Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. Acad Radiol. 2026. PMID: 42020230. doi:10.1016/j.acra.2026.03.052
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。