Post-TIPS Prediction via Multimodal Interaction: A Multi-Center Dataset and Framework for Survival, Complication, and Portal Pressure Assessment

Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for portal hypertension, but provides variable survival outcomes and frequent overt hepatic encephalopathy (OHE), indicating the necessity of accurate preoperative prognostic modeling. Current studies typically build machine learning models from preoperative CT images or clinical characteristics, but face three key challenges: (1) labor-intensive region-of-interest (ROI) annotation, (2) poor reliability and generalizability of unimodal methods, and (3) incomplete assessment from single-endpoint prediction. Moreover, the lack of publicly accessible datasets constrains research in this field. Therefore, we present MultiTIPS, the first public multi-center dataset for TIPS prognosis, and propose a novel multimodal prognostic framework based on it. The framework comprises three core modules: (1) dual-option segmentation, which integrates semi-supervised and foundation model-based pipelines to achieve robust ROI segmentation with limited annotations and facilitate subsequent feature extraction; (2) multimodal interaction, where three techniques, multi-grained radiomics attention (MGRA), progressive orthogonal disentanglement (POD), and clinically guided prognostic enhancement (CGPE), are introduced to enable cross-modal feature interaction and complementary representation integration, thus improving model accuracy and robustness; and (3) multi-task prediction, where a staged training strategy is used to perform stable optimization of survival, portal pressure gradient (PPG), and OHE prediction for comprehensive prognostic assessment. Extensive experiments on MultiTIPS demonstrate the superiority of the proposed method over state-of-the-art approaches, along with strong cross-domain generalization and interpretability, indicating its promise for clinical application. The dataset and code are available.