MR Elastography-based stiffness as a marker for predicting hepatocellular carcinoma refractory to transarterial chemoembolization.

OBJECTIVES: This study aimed to evaluate the value of MRE-based stiffness for preoperatively predicting HCC refractory to TACE. METHODS: This retrospective study included 112 patients with HCC who underwent MRI and three-dimensional (3D) MRE within one month before initial TACE from 2017 to 2024. Imaging features, clinical information and stiffness values were analyzed to develop the clinical-radiological and nomogram models. Two radiologists reviewed the images and treatment response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). TACE refractoriness was determined in patients after 1-2 TACE sessions based on AASLD guidelines. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were used to identify predictors of TACE refractoriness and evaluate model performances. The final models were validated by 1000 bootstrap resamples. Kaplan-Meier analysis was used to assess progression-free survival (PFS). RESULTS: Among 112 patients, 63 (56.3 %) met the criteria for TACE refractoriness. Multivariable analysis showed that tumor size, BCLC stage and tumor stiffness (TS) were independent predictors of TACE refractoriness (all p < 0.05) in the clinical-radiological-MRE nomogram model. After bootstrap validation, the combined nomogram model showed the highest predictive performance (AUC = 0.853) for predicting TACE refractoriness, outperformed the clinical-radiological model integrating morphological pattern, BCLC stage and incomplete capsule (AUC = 0.785, p = 0.044). Patients classified as TACE-refractory by the nomogram had significantly shorter PFS than those classified as TACE-responsive (p < 0.05). CONCLUSION: 3D MRE-based TS may serve as a complementary biomarker for predicting TACE refractoriness in HCC patients.