Published online Jan 28, 2024. doi: 10.3748/wjg.v30.i4.381
Peer-review started: October 31, 2023
First decision: November 24, 2023
Revised: December 5, 2023
Accepted: January 10, 2024
Article in press: January 10, 2024
Published online: January 28, 2024
Radiomics is a promising tool that may increase the value of Magnetic Resonance Imaging (MRI) for different tasks linked to the management of patients with hepatocellular carcinoma (HCC).
Over the last decade, there has been a substantial increase in radiomics studies in the field of HCC. Many of these studies have demonstrated the power of radiomic features for differential diagnosis, grading, predicting microvascular invasion, overall survival, recurrence, and treatment response. However, the use of radiomics in HCC is currently limited to academic literature, and no studies have yet been translated into clinical applications. This has led to doubts among clinicians about the radiomics validity. This is in part due to many issues related to the methodological quality of radiomic studies.
To summarize the status of MRI radiomic studies concerning HCC, using the radiomics quality score (RQS) to assess the quality of the methodology used in each study.
We systematically reviewed PubMed, Google Scholar, and Web of Science databases to identify original articles focused on using MRI radiomics for HCC management published between 2017 and 2023. The RQS tool was employed to evaluate the methodological quality of radiomic studies. Spearman’s correlation (ρ) analysis was conducted to investigate the association between RQS and journal metrics, as well as the characteristics of the studies. The threshold for statistical significance was established at P < 0.05.
127 articles were included, of which 43 focused on HCC prognosis, 39 on prediction of pathological findings, 16 on prediction of the expression of molecular markers outcomes, 18 had a diagnostic purpose, and 11 had multiple aims. Mean RQS was 8 ± 6.22, with the corresponding percentage of 24.15% ± 15.25% (ranging from 0.0 to 58.33%). RQS was positively correlated with journal impact factor (IF; ρ = 0.36, P =2.98 × 10-5), 5-years IF (ρ = 0.33, P = 1.56 × 10-4), number of patients involved (ρ = 0.51, P < 9.37 × 10-10) and number of radiomics features (ρ = 0.59, P < 4.59 × 10-13) extracted in the study, and time of publication (ρ = -0.23, P = 0.0072).
Although the MRI radiomics in HCC represents an auspicious tool for developing adequate personalized treatment as a noninvasive approach in HCC patients, our study revealed that studies in this field still lack the quality required to allow its introduction in clinical practice.
Although recent advantages in MRI radiomics can potentially satisfy the urgent need for noninvasive, radiation-free and quantitative strategies that can aid in HCC treatment decision making, studies in this field still lack the quality required to allow its introduction in clinical practice. Future studies including external validation and adhering to the standardization of radiomics features are necessary. Moreover, limitations and challenges related to feature reproducibility, analysis of the clinical utility, and openness of science need to be addressed. This work may provide new insights and contribute to a common understanding of the use of radiomics in the assessment of HCC.