Artificial Intelligence in the Diagnosis and Prognostic Stratification of Hepatocellular Carcinoma: Current Evidence, Clinical Applications, and Future Perspectives

The integration of artificial intelligence (AI) into medicine, oncology, and radiology represents a marked shift in the diagnosis, prognostication, and management of hepatocellular carcinoma (HCC), a malignancy with high global incidence and poor prognosis. This review examines the application of AI, including machine learning (ML) and deep learning (DL), across the spectrum of HCC care. As AI advances, new convolutional neural networks (CNNs) and other models are enhancing diagnostic accuracy, reducing interpretation times, and improving the characterization of liver lesions across major imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Beyond diagnosis, the transformative role of AI in prognostication is also improving, where AI can now noninvasively predict critical factors such as microvascular invasion, genetic mutation status, tumor recurrence, and treatment response. Furthermore, AI has shown promise in facilitating patient-specific treatment planning by stratifying patients for interventions such as transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT). The review also addresses the emerging fields of pathomics and the use of AI in positron emission tomography (PET), while critically evaluating the cost-effectiveness of these technologies. Despite its promise, the widespread clinical adoption of AI faces challenges, including limited generalizability, maintaining patient privacy, ethical considerations, and the need for robust prospective validation. Ultimately, this review illustrates that the future of HCC management lies in a collaborative, hybrid-intelligence model, where AI-driven insights augment clinical expertise to optimize diagnostic pathways, personalize therapy, and improve patient outcomes.