A Multiphase CT-Based Radiomics-Clinical Model to Identify Inadequate Future Liver Remnant Hypertrophy After Portal Vein Embolization Before Major Hepatectomy.

Purpose: To develop and internally validate a multiphase contrast-enhanced computed tomography (CT) based radiomics-clinical nomogram for pre-operative prediction of inadequate future liver remnant (FLR) hypertrophy after portal vein embolization (PVE), with the aim of guiding individualized surgical planning. Patients and Methods: We retrospectively enrolled patients who underwent PVE at our centre. Contrast-enhanced CT and clinical data were collected before and 2-5 weeks after PVE for calculated FLR (cFLR≥30% defined as adequate hypertrophy). After liver segmentation on triphasic CT, radiomic features were extracted and reduced by LASSO to build a Rad-signature. This signature was integrated with significant clinical variables into an MLP fusion model, visualised as a nomogram, and evaluated using ROC, calibration and decision-curve analyses. Results: A total of 98 patients were included in this study. The fusion model achieved an area under the receiver-operating-characteristic curve (AUC) of 0.913 (95% CI 0.846-0.981) in the training cohort and 0.833 (95% CI 0.605-1.000) in the internal test cohort, outperforming the clinical-only model (AUC 0.714; DeLong P = 0.017). Sensitivity and specificity in the test set were 0.824 and 1.000, respectively. Pre-PVE FLR, cFLR, serum pre-albumin, prior chemotherapy, hepatitis status and underlying cirrhosis were independent predictors of adequate hypertrophy. Decision-curve analysis demonstrated net clinical benefit within a threshold probability range of 20-80%. Conclusion: The proposed multiphase CECT radiomics-clinical nomogram showed potential for identifying patients at high risk of insufficient FLR hypertrophy after PVE. This internally validated model holds promise for supporting personalised planning in hepatobiliary surgery.