Foundation Model‐Enabled Pathology‐Informed MRI Model for Preoperative Prediction of Vessels Encapsulating Tumor Clusters in Resectable Hepatocellular Carcinoma: A Multicenter Retrospective Study
Year: 2026
Type: article
Abstract: Vessels encapsulating tumor clusters (VETC) are an aggressive vascular phenotype of hepatocellular carcinoma that is usually determined after surgery. A foundation model-enabled framework for pathology-informed VETC prediction on pretreatment magnetic resonance imaging (MRI), termed PIVOT, uses paired preoperative multiparametric MRI, postoperative hematoxylin and eosin whole-slide images, and CD34 immunohistochemistry during model development, while inference requires only preoperative MRI. PIVOT-MRI uses morphologic and vascular embedding alignment, and PIVOT-Clinical combines the PIVOT-MRI score with tumor size and alpha-fetoprotein. The multicenter retrospective study includes 2052 patients in a training cohort, an internal test cohort, and four external validation cohorts. PIVOT-MRI achieves an area under the receiver operating characteristic curve of 0.887 in the internal test cohort and 0.839-0.861 across external cohorts. PIVOT-Clinical increases the internal-test area under the curve to 0.904 and PIVOT-Clinical-defined groups are associated with different two-year recurrence risks. Removing both histopathologic alignment branches results in the largest ablation-related performance decrease. Exploratory radiotranscriptomic analyses showed that higher PIVOT-MRI scores were associated with angiogenesis-related, endothelial, and proliferative transcriptional programs. PIVOT enables noninvasive preoperative assessment of pathology-defined vascular aggressiveness in resectable hepatocellular carcinoma while preserving an MRI-only clinical inference pathway.
Source: Advanced Science
DOI: 10.1002/advs.78135
Institutions: Shanghai Jiao Tong University, Ruijin Hospital, Army Medical University, Southwest Hospital, Tongji University, Tongji Hospital, Shanghai University of Traditional Chinese Medicine, Shuguang Hospital, Macao Polytechnic University, Harvard University, Second Military Medical University, Eastern Hepatobiliary Surgery Hospital
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,730
OpenAlex ID: W7222905252