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Tumor viscoelasticity (comprising\n                      <jats:italic>c<\/jats:italic>\n                      and\n                      <jats:italic>\u03c6<\/jats:italic>\n                      ), imaging features and clinical information were analyzed and diagnostic models developed. Logistic regression and area-under-the-curve (AUC) methodology evaluated the models\u2019 efficacy for determining the MTM-HCC. RNA sequencing and KEGG pathway analyses identified differential gene expression between 12 high-\n                      <jats:italic>c<\/jats:italic>\n                      and 12 low-\n                      <jats:italic>c<\/jats:italic>\n                      tumor samples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In HCC patients with elevated Edmondson\u2013Steiner grades, satellite nodules, non-smooth margins, fat deficiency, or an arterial phase hypovascular component (APHC) more than 20%, tumor viscoelastic values\n                      <jats:italic>c<\/jats:italic>\n                      or\n                      <jats:italic>\u03c6<\/jats:italic>\n                      were higher, compared with patients without these features (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Tumor\n                      <jats:italic>c<\/jats:italic>\n                      (T-\n                      <jats:italic>c<\/jats:italic>\n                      ) was an independent predictor of MTM-HCC (AUC, 0.818; 95% confidence interval: 0.685, 0.950;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001); Combining T-\n                      <jats:italic>c<\/jats:italic>\n                      with \u2265\u200920% APHC yielded a higher AUC (0.843), but not significantly different from T-\n                      <jats:italic>c<\/jats:italic>\n                      alone (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.533). RNA sequencing showed high-\n                      <jats:italic>c<\/jats:italic>\n                      tumors upregulated cell proliferation and DNA replication genes but downregulated immune regulation genes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      MRE-derived T-\n                      <jats:italic>c<\/jats:italic>\n                      is a promising non-invasive biomarker for identifying MTM-HCC. HCCs with different T-\n                      <jats:italic>c<\/jats:italic>\n                      levels show distinct gene expression profiles, particularly in proliferation and immune pathways. Research with larger cohorts is needed to validate clinical utility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can MRE-based viscoelastic values identify the macrotrabecular-massive (MTM) subtype of HCC?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Tumor-c based on MRE has a unique diagnostic performance for identifying MTM-HCC; tumor stiffness correlates with proliferative and immune gene expression.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>MRE-based stiffness is a noninvasive predictor of MTM-HCC, and high-stiffness tumors show upregulation of proliferation genes and downregulation of immune genes. These findings may guide personalized treatment, but larger studies are required to confirm clinical applicability.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12024-y","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:02:39Z","timestamp":1759982559000},"page":"2388-2400","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Detection of macrotrabecular-massive hepatocellular carcinoma based on viscoelastic characteristics obtained by multifrequency magnetic-resonance elastography"],"prefix":"10.1007","volume":"36","author":[{"given":"Zhen","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunjie","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhong","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiyuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ze","family":"Mi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongpei","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Rong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"12024_CR1","doi-asserted-by":"crossref","unstructured":"Chan Y-T, Zhang C, Wu J et al (2024) Biomarkers for diagnosis and therapeutic options in hepatocellular carcinoma. 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