Multiple advanced diffusion models for preoperative prediction of macrotrabecular-massive subtype in solitary hepatocellular carcinoma

Motivation: Pretherapeutic characterization of the aggressive macrotrabecular-massive (MTM) subtype hepatocellular carcinoma (HCC) may promote the implementation of precision treatment and improvement of prognosis. Goal(s): To investigate the value of multiple advanced diffusion models in identifying the MTM subtype of HCC preoperatively. Approach: DWI of twelve b-values (0-2000 s/mm2) were performed in 70 patients with HCC. Multiple diffusion-derived parameters were extracted and compared between MTM and non-MTM HCC. The predictive efficacy of various diffusion parameters was assessed. Results: CTRW_α exhibited the highest predictive performance with an AUC of 0.861 among individual parameters, a combination of parameters could improve the AUC to 0.912. Impact: MTM is a distinct subtype of HCC and is associated with aggressive biological behavior, but it might be a suitable candidate for immunotherapy. Our result demonstrated that non-Gaussian diffusion parameters could serve as promising biomarkers for predicting MTM preoperatively.