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Purpose To develop a clinical-radiomics nomogram by incorporating radiomics score and clinical predictors for preoperative prediction of microvascular invasion in hepatocellular carcinoma. Methods A total of 97 HCC patients were retrospectively enrolled from Shanghai Universal Medical Imaging Diagnostic Center and Changhai Hospital Affiliated to the Second Military Medical University. 909 CT and 909 PET slicers from 97 HCC patients were divided into a training cohort (N = 637) and a validation cohort (N = 272). Radiomics features were extracted from each CT or PET slicer, and features selection was performed with least absolute shrinkage and selection operator regression and radiomics score was also generated. The clinical-radiomics nomogram was established by integrating radiomics score and clinical predictors, and the performance of the models were evaluated from its discrimination ability, calibration ability, and clinical usefulness. Results The radiomics score consisted of 45 selected features, and age, the ratio of maximum to minimum tumor diameter, and    $$^{18}$$  18 F-FDG uptake status were independent predictors of microvascular invasion. The clinical-radiomics nomogram showed better performance for MVI detection (0.890 [0.854, 0.927]) than the clinical nomogram (0.849 [0.804, 0.893]) (   $$p&lt;0.05$$  p &lt; 0.05 ). Both nomograms showed good calibration and the clinical-radiomics nomogram’s clinical practicability outperformed the clinical nomogram. Conclusions With the combination of radiomics score and clinical predictors, the clinical-radiomics nomogram can significantly improve the predictive efficacy of microvascular invasion in hepatocellular carcinoma (   $$p&lt;0.05$$  p &lt; 0.05 ) compared with clinical nomogram.

Preoperative clinical-radiomics nomogram for microvascular invasion prediction in hepatocellular carcinoma using $$^{18}$$F-FDG PET/CT