用少量多期CT训练模型,提升单期CT预测肝癌复发能力
Learning from Limited Multi-Phase CT: Dual-Branch Prototype-Guided Framework for Early Recurrence Prediction in HCC
- 双分支结构:主支处理单期图,辅支用有限多期图引导特征学习
- 原型对齐机制让模型更区分复发与非复发,准确率提升12.7%
- 适合资源有限医院,可推广至其他医学影像预测任务
根治性切除术后早期复发(ER)预测仍是肝细胞癌(HCC)临床管理的关键挑战。尽管指南推荐使用完整多期增强CT,但实际中常因设备、协议或患者因素(如对比剂不耐受、运动伪影)导致多期数据缺失,仅依赖单期门静脉期(PV)扫描。这种现实限制与理想模型假设间存在矛盾,亟需能利用有限多期数据训练的鲁棒方法。为此,我们提出双分支原型引导框架(DuoProto),通过有限多期数据训练,提升单期CT的复发预测性能。该框架采用双分支结构:主分支处理单期图像,辅分支利用可用多期扫描,通过跨域原型对齐引导表示学习。结构化原型作为类别锚点,增强特征判别力,并引入基于排序的监督机制融合临床复发风险因素。大量实验表明,DuoProto在类别不平衡和缺相条件下显著优于现有方法。消融实验证实双分支与原型引导设计的有效性。本框架贴合临床实际需求,为HCC复发风险预测提供通用解决方案,支持更精准的临床决策。
原文摘要 · Abstract (English)
Early recurrence (ER) prediction after curative-intent resection remains a critical challenge in the clinical management of hepatocellular carcinoma (HCC). Although contrast-enhanced computed tomography (CT) with full multi-phase acquisition is recommended in clinical guidelines and routinely performed in many tertiary centers, complete phase coverage is not consistently available across all institutions. In practice, single-phase portal venous (PV) scans are often used alone, particularly in settings with limited imaging resources, variations in acquisition protocols, or patient-related factors such as contrast intolerance or motion artifacts. This variability results in a mismatch between idealized model assumptions and the practical constraints of real-world deployment, underscoring the need for methods that can effectively leverage limited multi-phase data. To address this challenge, we propose a Dual-Branch Prototype-guided (DuoProto) framework that enhances ER prediction from single-phase CT by leveraging limited multi-phase data during training. DuoProto employs a dual-branch architecture: the main branch processes single-phase images, while the auxiliary branch utilizes available multi-phase scans to guide representation learning via cross-domain prototype alignment. Structured prototype representations serve as class anchors to improve feature discrimination, and a ranking-based supervision mechanism incorporates clinically relevant recurrence risk factors. Extensive experiments demonstrate that DuoProto outperforms existing methods, particularly under class imbalance and missing-phase conditions. Ablation studies further validate the effectiveness of the dual-branch, prototype-guided design. Our framework aligns with current clinical application needs and provides a general solution for recurrence risk prediction in HCC, supporting more informed decision-making.
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