Dual-Energy Computed Tomography Iodine Imaging Combined with Laboratory Data for Preoperative Evaluation of Microvascular Invasion in Patients with Hepatocellular Carcinoma: A Two-Center Study

Purpose: Microvascular invasion (MVI) is a recognized biomarker associated with poorer prognosis in patients with hepatocellular carcinoma (HCC). Dual-energy computed tomography (DECT) is a highly sensitive technique that can determine the iodine concentration (IC) in tumor and provide an indirect evaluation of internal microcirculatory perfusion. This study aimed to assess whether the combination of DECT with laboratory data can improve preoperative MVI prediction. Methods This retrospective study enrolled 119 patients who underwent DECT liver angiography at two medical centers preoperatively. To compare DECT parameters and laboratory findings between MVI-negative and -positive groups, Mann-Whitney U test was employed. Additionally, principal component analysis (PCA) was conducted to determine fundamental components. Mann-Whitney U test was applied to determine whether the PC scores varied across MVI groups. Finally, a general linear classifier was used to assess the classification ability of each PC score. Results Significant differences were noted ( P  < 0.05) in AFP level, normalized arterial phase IC, and normalized portal phase IC between the MVI groups in the primary and validation datasets. The PC1–PC4 accounted for 67.9% of the variance in the primary dataset, with loadings of 24.1%, 16%, 15.4%, and 12.4%, respectively. In both primary and validation datasets, PC3 and PC4 were significantly different across MVI groups, with area under the curve values of 0.8410 and 0.8373, respectively. Conclusion Both bilirubin parameters and the intratumoral IC in the arterial phase were considered important for MVI analysis, the recombination of DECT iodine concentration and laboratory features based on varying factor loadings can well predict MVI preoperatively.