Combined Model for the Diagnosis of Hepatocellular Carcinoma: A Pilot Study Comparing the Liver to Spleen Volume Ratio and Liver Vein to Cava Attenuation

<b>Background/Objectives:</b> Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality and often develops in the context of liver cirrhosis (LC). Its detection remains a clinical challenge, particularly with limited sensitivity of the current serum biomarkers and qualitative imaging tools. The aim of this pilot study is to evaluate the application of a combined model based on the use of Liver to Spleen Volume Ratio (LSVR), a score of regional liver remodeling, and Liver Vein to Cava Attenuation (LVCA), a computed tomography (CT)-based perfusion-related parameter, to diagnose HCC in patients with LC. <b>Methods</b>: In this observational retrospective pilot study, 36 patients with LC, with or without HCC, were enrolled from a single tertiary care center between 2021 and 2024. Demographic, clinical, biochemical, and imaging data were collected. LSVR and LVCA were calculated from contrast-enhanced CT scans. Predictors of HCC were assessed using conditional inference trees and multivariate logistic regression. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). A <i>p</i>-value < 0.05 was considered statistically significant. <b>Results</b>: LVCA and LSVR levels were significantly higher in the HCC group (<i>p</i> < 0.001). In multivariate analysis, LVCA was significantly associated with HCC onset (Odds Ratio = 2.88, <i>p</i> = 0.0075). The final model incorporating both LVCA and LSVR achieved excellent discrimination (AUC = 0.967), with 91% sensitivity and 88% specificity. The combined model outperformed LSVR alone (<i>p</i> = 0.030), though not LVCA alone. <b>Conclusions</b>: Our pilot study suggests the utility of LVCA and LSVR as potential non-invasive imaging tools for HCC diagnosis. External validation in multicenter cohorts and longitudinal studies assessing the temporal evolution of LSVR and LVCA are necessary to better evaluate their application in clinical practice.