Exploring the Value of a Radiomics Model Based on Hepatobiliary Phase Magnetic Resonance Imaging in Predicting Glypican-3-Positive Hepatocellular Carcinoma

Background Hepatocellular carcinoma (HCC) is the most common primary liver cancer (70%-80% of cases) with a heavy global disease burden and high postoperative recurrence rate, highlighting the need for improved preoperative diagnosis. Glypican-3 (GPC3) is a key diagnostic/therapeutic biomarker for HCC, but current detection relies on invasive methods (postoperative immunohistochemistry, preoperative needle biopsy) with limitations. Hepatobiliary phase contrast-enhanced MRI (HBP-MRI) and radiomics offer promising noninvasive alternatives. Purpose To explore the value of an HBP-MRI-based radiomics model for noninvasive preoperative prediction of GPC3-positive HCC, and develop an optimized model integrating imaging and clinical features. Methods A total of 151 HCC patients who underwent Gd-EOB-DTPA-enhanced MRI and hepatic resection/needle biopsy (2020–2024) were retrospectively divided into training (n = 107) and validation (n = 44) cohorts (7:3 ratio). Eight hundred fifty radiomic features were extracted via 3D Slicer, filtered by ICC (≥ 0.75), independent sample t-tests (P < 0.05), and LASSO (11 key features retained). Eight machine learning models were constructed; the optimal model was combined with clinical factors (AFP, liver cirrhosis) to form a combined model. Performance was evaluated by ROC curves, calibration curves, and DCA. Results The random forest model performed best (training AUC = 0.918; validation AUC = 0.903). The combined model achieved superior efficacy (training AUC = 0.936; validation AUC = 0.940), outperforming the clinical model (AUC = 0.762) and standalone radiomics model, with the highest net clinical benefit confirmed by DCA. Conclusions The HBP-MRI-based radiomics model enables noninvasive prediction of GPC3-positive HCC. The nomogram integrating radiomic score and clinical features exhibits higher diagnostic efficacy, providing a novel noninvasive tool for personalized HCC management.