An imageomics and multi-network based deep learning model for risk assessment of liver transplantation for hepatocellular cancer
Open accessAbstract
Introduction Liver transplantation (LT) is an effective treatment for hepatocellular carcinoma (HCC), the most common type of primary liver cancer. Patients with small HCC (<5 cm) are given priority over others for transplantation due to clinical allocation policies based on tumor size. Attempting to shift from the prevalent paradigm that successful transplantation and longer disease-free survival can only be achieved in patients with small HCC to expanding the transplantation option to patients with HCC of the highest tumor burden (>5 cm), we developed a convergent artificial intelligence (AI) model that combines transient clinical data with quantitative histologic and radiomic features for more objective risk assessment of liver transplantation for HCC patients. Methods Patients who received a LT for HCC between 2008-2019 were eligible for inclusion in the analysis. All patients with post-LT recurrence were included, and those without recurrence were randomly selected for inclusion in the deep learning model. Pre- and post-transplant magnetic resonance imaging (MRI) scans and reports were compressed using CapsNet networks and natural language processing, respectively, as input for a multiple feature radial basis function network. We applied a histological image analysis algorithm to detect pathologic areas of interest from explant tissue of patients who recurred. The multilayer perceptron was designed as a feed-forward, supervised neural network topology, with the final assessment of recurrence risk. We used area under the curve (AUC) and F-1 score to assess the predictability of different network combinations. Results A total of 109 patients were included (87 in the training group, 22 in the testing group), of which 20 were positive for cancer recurrence. Seven models (AUC; F-1 score) were generated, including clinical features only (0.55; 0.52), magnetic resonance imaging (MRI) only (0.64; 0.61), pathological images only (0.64; 0.61), MRI plus pathology (0.68; 0.65), MRI plus clinical (0.78, 0.75), pathology plus clinical (0.77; 0.73), and a combination of clinical, MRI, and pathology features (0.87; 0.84). The final combined model showed 80 % recall and 89 % precision. The total accuracy of the implemented model was 82 %. Conclusion We validated that the deep learning model combining clinical features and multi-scale histopathologic and radiomic image features can be used to discover risk factors for recurrence beyond tumor size and biomarker analysis. Such a predictive, convergent AI model has the potential to alter the LT allocation system for HCC patients and expand the transplantation treatment option to patients with HCC of the highest tumor burden.
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Various combinations of imaging, clinical, and genomic modalities can be fused for tasks such as AD prediction, AD stage detection, and liver transplantation risk assessment.
“For instance, MRI and clinical data can be fused for AD prediction [72] or MRI, clinical and genomic modalities can be fused for AD stage detection [69]. Also, latent representations of multiple imaging modalities and clinical data can be fused for risk assessment of liver transplantation for hepatocellular cancer [71].”
From Multimodal deep learning for biomedical data fusion: a review (2022) · cites this paper as [71]
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- Authors
- He, T., Fong, J. N., Moore, L. W., Ezeana, C. F., Victor, D., Divatia, M., Vasquez, M., Ghobrial, R. M., & Wong, S. T. C.
- Affiliations
- Houston Methodist (US)
- Corresponding author
- Ghobrial, R. Mark
- Wong, Stephen T.C.
- ORCID
- Venue
- Computerized Medical Imaging and Graphics
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 89
- Pages
- 101894
- ISSN
- 0730-4862 (ISSN-L)
- 0895-6111
- PMC
- PMC8054468
- OpenAlex
- W3135798895
- Cited by
- 63
- References
- 57
- Citations by year
- 2026: 5 · 2025: 17 · 2024: 14 · 2023: 14 · 2022: 10 · 2021: 3
- FWCI
- 5.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Computerized Medical Imaging and Graphics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- John S Dunn Foundation
- National Institutes of Health
- Ting Tsung and Wei Fong Chao Family Foundation
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
- Keywords
- liver transplantation, hepatocellular carcinoma, recurrence risk prediction, radiomics, histopathology, magnetic resonance imaging, capsule networks, natural language processing, imageomics, tumor size, organ allocation, post-transplant relapse, radial basis function neural network, multilayer perceptron, clinical risk assessment
- MeSH terms
- Deep Learning, Artificial Intelligence, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Liver Transplantation, Risk Assessment
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