Publication Name	World Journal of Gastroenterology
Manuscript ID	120606
Country	United States

Category	Oncology
Manuscript Type	Editorial
Article Title	Imaging tumor heterogeneity to predict response to transarterial chemoembolization in hepatocellular carcinoma
Manuscript Source	Invited Manuscript
All Author List	Arunkumar Krishnan
Funding Agency and Grant Number
Corresponding Author	Arunkumar Krishnan, MD, Department of Supportive Oncology, Atrium Health Levine Cancer, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, 1021 Morehead Medical Dr, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Key Words	Hepatocellular carcinoma; Transarterial chemoembolization; Intratumoral heterogeneity; Habitat imaging; Magnetic resonance imaging; Radiomics; Predictive modeling; Personalized medicine
Core Tip	The study by Lv et al integrated contrast-enhanced magnetic resonance imaging-derived habitat features, conventional radiomics, and clinical variables to predict early response to transarterial chemoembolization in hepatocellular carcinoma, achieving area under the curve values of 0.97 and 0.93 in the training and validation cohorts, respectively. While the ecological diversity index and multicenter design are meaningful advancements, several key methodological issues remain unresolved: Feature selection outside nested cross-validation, which risks data leakage and overly optimistic performance estimates; confounding from mixed protocols; outcome misclassification due to the use of both computed tomography and magnetic resonance imaging follow-up; and insufficient inter-site harmonization. Prospective validation, integration of multi-sequence imaging, and studies analyzing the impact on decision-making are necessary before implementing this in clinical practice.
Citation	Krishnan A. Imaging tumor heterogeneity to predict response to transarterial chemoembolization in hepatocellular carcinoma. World J Gastroenterol 2026; In press

Received	2026-03-03 03:14
Peer-Review Started	2026-03-03 03:15
First Decision by Editorial Office Director	2026-04-17 08:11
Return for Revision	2026-04-17 08:11
Revised	2026-04-20 17:15
Publication Fee Transferred
Second Decision by Editor	2026-05-25 02:36
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-05-25 07:48
Articles in Press	2026-05-25 07:48
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1007-9327 (print) and 2219-2840 (online)
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