An Interpretable Radiomics Model Based on Two-Dimensional Shear Wave Elastography for Predicting Symptomatic Post-Hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Xian Zhong; Zohaib Salahuddin; Yi Chen; Henry C Woodruff; Haiyi Long; Jianyun Peng; Xiaoyan Xie; Manxia Lin; Philippe Lambin

doi:10.3390/cancers15215303

An Interpretable Radiomics Model Based on Two-Dimensional Shear Wave Elastography for Predicting Symptomatic Post-Hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Cancers (Basel). 2023 Nov 6;15(21):5303. doi: 10.3390/cancers15215303.

Authors

Xian Zhong^{1

2}, Zohaib Salahuddin², Yi Chen^{2

3}, Henry C Woodruff^{2

4}, Haiyi Long¹, Jianyun Peng¹, Xiaoyan Xie¹, Manxia Lin¹, Philippe Lambin^{2

4}

Affiliations

¹ Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
² The D-Lab, Department of Precision Medicine, GROW-School for Oncology and Reproduction, Maastricht University, 6220 MD Maastricht, The Netherlands.
³ Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis, College of Computer Science and Technology, Guizhou University, Guiyang 550025, China.
⁴ Department of Radiology and Nuclear Medicine, GROW-School for Oncology and Reproduction, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands.

Abstract

Objective: The aim of this study was to develop and validate an interpretable radiomics model based on two-dimensional shear wave elastography (2D-SWE) for symptomatic post-hepatectomy liver failure (PHLF) prediction in patients undergoing liver resection for hepatocellular carcinoma (HCC).

Methods: A total of 345 consecutive patients were enrolled. A five-fold cross-validation was performed during training, and the models were evaluated in the independent test cohort. A multi-patch radiomics model was established based on the 2D-SWE images for predicting symptomatic PHLF. Clinical features were incorporated into the models to train the clinical-radiomics model. The radiomics model and the clinical-radiomics model were compared with the clinical model comprising clinical variables and other clinical predictive indices, including the model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score. Shapley Additive exPlanations (SHAP) was used for post hoc interpretability of the radiomics model.

Results: The clinical-radiomics model achieved an AUC of 0.867 (95% CI 0.787-0.947) in the five-fold cross-validation, and this score was higher than that of the clinical model (AUC: 0.809; 95% CI: 0.715-0.902) and the radiomics model (AUC: 0.746; 95% CI: 0.681-0.811). The clinical-radiomics model showed an AUC of 0.822 in the test cohort, higher than that of the clinical model (AUC: 0.684, p = 0.007), radiomics model (AUC: 0.784, p = 0.415), MELD score (AUC: 0.529, p < 0.001), and ALBI score (AUC: 0.644, p = 0.016). The SHAP analysis showed that the first-order radiomics features, including first-order maximum 64 × 64, first-order 90th percentile 64 × 64, and first-order 10th percentile 32 × 32, were the most important features for PHLF prediction.

Conclusion: An interpretable clinical-radiomics model based on 2D-SWE and clinical variables can help in predicting symptomatic PHLF in HCC.

Keywords: hepatocellular carcinoma; interpretability; post-hepatectomy liver failure; radiomics; two-dimensional shear wave elastography.

Abstract

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