Predicting early recurrence of hepatocellular carcinoma after thermal ablation based on longitudinal MRI with a deep learning approach.

backgroundAccurate prediction of early recurrence (ER) is essential to improve the prognosis of patients with hepatocellular carcinoma (HCC) underwent thermal ablation (TA). Therefore, a deep learning model system using longitudinal magnetic resonance imaging (MRI) was developed to predict ER of patients with HCC.

methodsFrom 2014, April to 2017, May, a total of 289 eligible patients with HCC underwent TA were retrospectively enrolled from 3 hospitals and assigned into one training cohort (n = 254) and one external testing cohort (n = 35). Two deep learning models (Pre and PrePost) were developed using the pre-operative MRI and longitudinal MRI (pre- and post-operative) to predict ER for the patients with HCC after TA, respectively. Then, an integrated model (DL_Clinical) incorporating PrePost model signature and clinical variables was built for post-ablation ER risk stratification for the patients with HCC.

resultsIn the external testing cohort, the area under the receiver operating characteristic curve (AUC) of the DL_Clinical model was better than that of the Clinical (0.740 vs 0.571), Pre (0.740 vs 0.648), and PrePost model (0.740 vs 0.689). Additionally, there was a significant difference in RFS between the high- and low-risk groups which were divided by the DL_Clinical model (P = .04).

conclusionsThe PrePost model developed using longitudinal MRI showed outstanding performance for predicting post-ablation ER of HCC. The DL_Clinical model could stratify the patients into high- and low-risk groups, which may help physicians in treatment and surveillance strategy selection in clinical practice.