Liu K, Li JB, Wang Y, Li Y. Magnetic resonance imaging bias field correction improves tumor prognostic evaluation after transcatheter arterial chemoembolization for liver cancer. World J Gastrointest Surg 2025; 17(4): 104187 [DOI: 10.4240/wjgs.v17.i4.104187]
Corresponding Author of This Article
Yan Li, Senior Researcher, Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221002, Jiangsu Province, China. mango_2023@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2025; 17(4): 104187 Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104187
Magnetic resonance imaging bias field correction improves tumor prognostic evaluation after transcatheter arterial chemoembolization for liver cancer
Ke Liu, Jun-Biao Li, Yong Wang, Yan Li
Ke Liu, Department of Hepatology, The Infectious Disease Hospital of Xuzhou, Xuzhou 221018, Jiangsu Province, China
Jun-Biao Li, Yong Wang, Yan Li, Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
Author contributions: Liu K and Li Y conceived and designed the study; Li JB and Wang Y collected and curated the data; Liu K and Li JB performed the methodology and formal analysis, and drafted the manuscript; Wang Y and Li Y acted as translators, and critically revised it for important intellectual content; Li Y supervised the entire project; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University, approval No. XYFY2021-KL271-02.
Informed consent statement: Given the retrospective design of this study, the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University waived the requirement for obtaining individual informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets utilized and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Li, Senior Researcher, Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221002, Jiangsu Province, China. mango_2023@163.com
Received: December 20, 2024 Revised: January 23, 2025 Accepted: March 7, 2025 Published online: April 27, 2025 Processing time: 98 Days and 23.1 Hours
Abstract
BACKGROUND
Transcatheter arterial chemoembolization (TACE) is a key treatment approach for advanced invasive liver cancer (infiltrative hepatocellular carcinoma). However, its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern. Volumetric imaging, especially enhanced tumor volume (ETV), offers a more comprehensive assessment. Nonetheless, bias field inhomogeneity in magnetic resonance imaging (MRI) poses challenges, potentially skewing volumetric measurements and undermining prognostic evaluation.
AIM
To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE, and to analyze how this improved measurement impacts prognostic prediction.
METHODS
We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024. The improved N4 bias field correction algorithm was applied to process MRI images, and the ETV before and after treatment was calculated. The ETV measurements before and after correction were compared, and their relationship with patient prognosis was analyzed. A Cox proportional hazards model was used to evaluate prognostic factors, with Martingale residual analysis determining the optimal cutoff value, followed by survival analysis.
RESULTS
Bias field correction significantly affected ETV measurements, with the corrected baseline ETV mean (505.235 cm³) being significantly lower than before correction (825.632 cm³, P < 0.001). Cox analysis showed that the hazard ratio (HR) for corrected baseline ETV (HR = 1.165, 95%CI: 1.069-1.268) was higher than before correction (HR = 1.063, 95%CI: 1.031-1.095). Using 412 cm³ as the cutoff, the group with baseline ETV < 415 cm³ had a longer median survival time compared to the ≥ 415 cm³ group (18.523 months vs 8.926 months, P < 0.001). The group with an ETV reduction rate ≥ 41% had better prognosis than the < 41% group (17.862 months vs 9.235 months, P = 0.006). Multivariate analysis confirmed that ETV reduction rate (HR = 0.412, P < 0.001), Child-Pugh classification (HR = 0.298, P < 0.001), and Barcelona Clinic Liver Cancer stage (HR = 0.578, P = 0.045) were independent prognostic factors.
CONCLUSION
Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer. The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis, providing important reference for developing individualized treatment strategies.
Core Tip: This study highlights the value of magnetic resonance imaging bias field correction in improving enhanced tumor volume measurements for evaluating transcatheter arterial chemoembolization efficacy in invasive liver cancer. Corrected enhanced tumor volume and its reduction rate were identified as independent prognostic factors, enhancing accuracy in assessing tumor burden and outcomes. These findings support integrating bias field correction into imaging protocols to optimize treatment strategies and improve prognostic evaluations in interventional oncology.
