Radiomics of Hepatocellular Carcinoma: Identifying Predictors of Microvascular Invasion Using Multi-Phase CT Analysis

<b>Objective:</b> To explore radiomic texture features from multi-phase contrast-enhanced CT as potential predictors of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). <b>Materials and Methods:</b> This exploratory single-center study retrospectively analyzed 49 patients (54 HCC lesions) who underwent liver resection between 2018-2022. Radiomic analysis extracted 642 features across arterial, venous, and delayed phases using original and 5 mm-expanded tumor margins. <b>Results:</b> The 20-50 mm lesion subgroup (<i>n</i> = 37) provided the most reliable results, with arterial phase texture homogeneity features achieving AUC 0.772. Features from lesions <20 mm (<i>n</i> = 14, 4 MVI+) showed clear evidence of overfitting and were excluded from primary analyses. Delayed phase features showed preliminary associations (AUC 0.8) in a small LR-3/4 subset (<i>n</i> = 20). <b>Limitations:</b> This hypothesis-generating study has significant limitations including small sample size, single-center design, and lack of correction for multiple comparisons. <b>Conclusions:</b> Multi-phase CT radiomic analysis shows potential for MVI prediction in intermediate-sized HCC lesions, though external validation in larger cohorts is essential before clinical application.