Transformer model based on Sonazoid contrast‐enhanced ultrasound for microvascular invasion prediction in hepatocellular carcinoma

Abstract Background Microvascular invasion (MVI) is strongly associated with the prognosis of patients with hepatocellular carcinoma (HCC). Purpose To evaluate the value of Transformer models with Sonazoid contrast‐enhanced ultrasound (CEUS) in the preoperative prediction of MVI. Methods This retrospective study included 164 HCC patients. Deep learning features and radiomic features were extracted from arterial and Kupffer phase images, alongside the collection of clinicopathological parameters. Normality was assessed using the Shapiro–Wilk test. The Mann‒Whitney U ‐test and least absolute shrinkage and selection operator algorithm were applied to screen features. Transformer, radiomic, and clinical prediction models for MVI were constructed with logistic regression. Repeated random splits followed a 7:3 ratio, with model performance evaluated over 50 iterations. The area under the receiver operating characteristic curve (AUC, 95% confidence interval [CI]), sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), decision curve, and calibration curve were used to evaluate the performance of the models. The DeLong test was applied to compare performance between models. The Bonferroni method was used to control type I error rates arising from multiple comparisons. A two‐sided p ‐value of < 0.05 was considered statistically significant. Results In the training set, the diagnostic performance of the arterial‐phase Transformer (AT) and Kupffer‐phase Transformer (KT) models were better than that of the radiomic and clinical (Clin) models ( p < 0.0001). In the validation set, both the AT and KT models outperformed the radiomic and Clin models in terms of diagnostic performance ( p < 0.05). The AUC (95% CI) for the AT model was 0.821 (0.72–0.925) with an accuracy of 80.0%, and the KT model was 0.859 (0.766–0.977) with an accuracy of 70.0%. Logistic regression analysis indicated that tumor size ( p = 0.016) and alpha‐fetoprotein (AFP) ( p = 0.046) were independent predictors of MVI. Conclusions Transformer models using Sonazoid CEUS have potential for effectively identifying MVI‐positive patients preoperatively.