Abstract
OBJECTIVES: To develop and validate radiomics and deep learning models based on contrast-enhanced MRI (CE-MRI) for differentiating dual-phenotype hepatocellular carcinoma (DPHCC) from HCC and intrahepatic cholangiocarcinoma (ICC). METHODS: Our study consisted of 381 patients from four centers with 138 HCCs, 122 DPHCCs, and 121 ICCs (244 for training and 62 for internal tests, centers 1 and 2; 75 for external tests, centers 3 and 4). Radiomics, deep transfer learning (DTL), and fusion models based on CE-MRI were established for differential diagnosis, respectively, and their diagnostic performances were compared using the confusion matrix and area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: The radiomics model demonstrated competent diagnostic performance, with a macro-AUC exceeding 0.9, and both accuracy and F1-score above 0.75 in the internal and external validation sets. Notably, the vgg19-combined model outperformed the radiomics and other DTL models. The fusion model based on vgg19 further improved diagnostic performance, achieving a macro-AUC of 0.990 (95% CI: 0.965-1.000), an accuracy of 0.935, and an F1-score of 0.937 in the internal test set. In the external test set, it similarly performed well, with a macro-AUC of 0.988 (95% CI: 0.964-1.000), accuracy of 0.875, and an F1-score of 0.885. CONCLUSIONS: Both the radiomics and the DTL models were able to differentiate DPHCC from HCC and ICC before surgery. The fusion models showed better diagnostic accuracy, which has important value in clinical application. CRITICAL RELEVANCE STATEMENT: MRI-based deep learning radiomics were able to differentiate DPHCC from HCC and ICC preoperatively, aiding clinicians in the identification and targeted treatment of these malignant hepatic tumors. KEY POINTS: Fusion models may yield an incremental value over radiomics models in differential diagnosis. Radiomics and deep learning effectively differentiate the three types of malignant hepatic tumors. The fusion models may enhance clinical decision-making for malignant hepatic tumors.