An Interpretable Radiomics Model Based on Two-Dimensional Shear Wave Elastography for Predicting Symptomatic Post-Hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

SIMPLE SUMMARY: Two-dimensional shear wave elastography (2D-SWE) has demonstrated predictive value for symptomatic post-hepatectomy liver failure (PHLF) in hepatocellular carcinoma (HCC). Our aim was to develop and validate an interpretable radiomics model based on 2D-SWE for predicting symptomatic PHLF in patients undergoing liver resection for HCC. We proposed an interpretable clinical–radiomics model based on both multi-patch radiomics and clinical features, which showed an AUC of 0.822 in the test cohort, higher than the clinical model (AUC: 0.684, p = 0.007), radiomics model (AUC: 0.784, p = 0.415), end-stage liver disease (MELD) score (AUC: 0.529, p < 0.001), and albumin–bilirubin (ALBI) score (AUC: 0.644, p = 0.016). The SHAP analysis showed that first-order radiomics features were the most important features for PHLF prediction. The clinical–radiomics model is useful for predicting symptomatic PHLF in HCC with high model interpretability, which may serve as a useful tool for therapeutic decision making to improve perioperative management. ABSTRACT: Objective: The aim of this study was to develop and validate an interpretable radiomics model based on two-dimensional shear wave elastography (2D-SWE) for symptomatic post-hepatectomy liver failure (PHLF) prediction in patients undergoing liver resection for hepatocellular carcinoma (HCC). Methods: A total of 345 consecutive patients were enrolled. A five-fold cross-validation was performed during training, and the models were evaluated in the independent test cohort. A multi-patch radiomics model was established based on the 2D-SWE images for predicting symptomatic PHLF. Clinical features were incorporated into the models to train the clinical–radiomics model. The radiomics model and the clinical–radiomics model were compared with the clinical model comprising clinical variables and other clinical predictive indices, including the model for end-stage liver disease (MELD) score and albumin–bilirubin (ALBI) score. Shapley Additive exPlanations (SHAP) was used for post hoc interpretability of the radiomics model. Results: The clinical–radiomics model achieved an AUC of 0.867 (95% CI 0.787–0.947) in the five-fold cross-validation, and this score was higher than that of the clinical model (AUC: 0.809; 95% CI: 0.715–0.902) and the radiomics model (AUC: 0.746; 95% CI: 0.681–0.811). The clinical–radiomics model showed an AUC of 0.822 in the test cohort, higher than that of the clinical model (AUC: 0.684, p = 0.007), radiomics model (AUC: 0.784, p = 0.415), MELD score (AUC: 0.529, p < 0.001), and ALBI score (AUC: 0.644, p = 0.016). The SHAP analysis showed that the first-order radiomics features, including first-order maximum 64 × 64, first-order 90th percentile 64 × 64, and first-order 10th percentile 32 × 32, were the most important features for PHLF prediction. Conclusion: An interpretable clinical–radiomics model based on 2D-SWE and clinical variables can help in predicting symptomatic PHLF in HCC.