Jiyun Zhang ^* Maotong Liu Qi Qu ^* Mengtian Lu ^* Zixin Liu ^* Zuyi Yan ^* Lei Xu ^* Chunyan Gu ^* Xueqin Zhang ^* Tao Zhang ^*

• Affiliated Nantong Hospital 3 of Nantong University, Nantong, China

Purpose: The aim of this study was to develop an integrated model that combines clinicalradiologic and radiomics features based on gadoxetic acid-enhanced MRI for preoperative evaluating of vessels encapsulating tumor clusters (VETC) patterns in hepatocellular carcinoma (HCC). Methods: This retrospective study encompassed 234 patients who underwent surgical resection. Among them, 101 patients exhibited VETC-positive HCC, while 133 patients displayed VETC-negative HCC. Volumes of interest were manually delineated for entire tumor regions in the arterial phase (AP), portal phase (PP), and hepatobiliary phase (HBP) images. Independent predictors for VETC were identified through least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis, utilizing radiomics-AP, PP, HBP, along with 24 imaging features and 19 clinical characteristics. Subsequently, the clinico-radiologic model, radiomics model, and integrated model were established, with a nomogram visualizing the integrated model. The performance for VETC prediction was evaluated using a receiver operating characteristic curve. Results: The integrated model, composed of 3 selected traditional imaging features (necrosis or severe ischemia [OR=2.457], peripheral washout [OR=1.678], LLR_AP (Lesion to liver ratio_AP) [OR=0.433] and radiomics-AP [OR=2.870], radiomics-HBP [OR=2.023], radiomics-PP [OR=1.546]), showcased good accuracy in predicting VETC patterns in both the training (AUC=0.873, 95% confidence interval [CI]: 0.821-0.925)) and validation (AUC=0.869, 95% CI:0.789-0.950) cohorts. Conclusion: This study established an integrated model that combines traditional imaging features and radiomic features from gadoxetic acid-enhanced MRI, demonstrating good performance in predicting VETC patterns.