ArticleBMC medical imaging2026
Can incorporating preoperative arterial enhancement ratio map into habitat analysis predict TACE refractoriness in unresectable hepatocellular carcinoma?
Article in BMC medical imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo investigate the value of applying preoperative magnetic resonance imaging (MRI)-based arterial enhancement ratio (AER) map to habitat analysis for predicting transarterial chemoembolization (TACE) refractoriness in patients with unresectable hepatocellular carcinoma (HCC).
methods176 patients with unresectable HCC who underwent preoperative contrast-enhanced MRI and received consecutive TACE treatments were randomly allocated to a training cohort (n = 124) and a validation cohort (n = 52). A dual-mode encoding strategy (mode 1: based on T1-pre; mode 2: based on T1-pre with the AER map) was employed to define tumor habitats. Signal intensity, entropy, and volume fraction were quantified for each habitat. Combined with laboratory findings and imaging features, logistic regression analyses were performed to identify independent risk factors for TACE refractoriness and a predictive model was constructed. The performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC).
resultsEach tumor lesion was segmented into 5 habitats using mode 1 and 3 habitats using mode 2. Regression analysis identified Barcelona Clinic Liver Cancer stage (OR = 2.099, P = 0.027), blood products in mass (OR = 11.063, P = 0.028), and AER entropy value of habitat 2 derived from mode 2 (OR = 4.586, P = 0.033) as independent factors for predicting TACE refractoriness. AUC value of the nomogram on validation cohort was 0.721 (95% CI = 0.577-0.866). Calibration curve demonstrated favorable clinical applicability of the model.
conclusionIncorporation of the AER map into habitat analysis enables preoperative prediction of TACE refractoriness risk in patients with unresectable HCC. CLINICAL TRIAL NUMBER: Not applicable.
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