Korean J Radiol.  2019 Apr;20(4):569-579. 10.3348/kjr.2018.0501.

Hepatocellular Carcinoma: Texture Analysis of Preoperative Computed Tomography Images Can Provide Markers of Tumor Grade and Disease-Free Survival

• Oh J
• Lee JM
• Park J
• Joo I
• Yoon JH
• Lee DH
• Ganeshan B
• Han JK

• KMID: 2440480
• DOI: http://doi.org/10.3348/kjr.2018.0501

Abstract

OBJECTIVE
To investigate the usefulness of computed tomography (CT) texture analysis (CTTA) in estimating histologic tumor grade and in predicting disease-free survival (DFS) after surgical resection in patients with hepatocellular carcinoma (HCC).
MATERIALS AND METHODS
Eighty-one patients with a single HCC who had undergone quadriphasic liver CT followed by surgical resection were enrolled. Texture analysis of tumors on preoperative CT images was performed using commercially available software. The mean, mean of positive pixels (MPP), entropy, kurtosis, skewness, and standard deviation (SD) of the pixel distribution histogram were derived with and without filtration. The texture features were then compared between groups classified according to histologic grade. Kaplan-Meier and Cox proportional hazards analyses were performed to determine the relationship between texture features and DFS.
RESULTS
SD and MPP quantified from fine to coarse textures on arterial-phase CT images showed significant positive associations with the histologic grade of HCC (p < 0.05). Kaplan-Meier analysis identified most CT texture features across the different filters from fine to coarse texture scales as significant univariate markers of DFS. Cox proportional hazards analysis identified skewness on arterial-phase images (fine texture scale, spatial scaling factor [SSF] 2.0, p <001; medium texture scale, SSF 3.0, p <001), tumor size (p = 0.001), microscopic vascular invasion (p = 0.034), rim arterial enhancement (p = 0.024), and peritumoral parenchymal enhancement (p = 0.010) as independent predictors of DFS.
CONCLUSION
CTTA was demonstrated to provide texture features significantly correlated with higher tumor grade as well as predictive markers of DFS after surgical resection of HCCs in addition to other valuable imaging and clinico-pathologic parameters.

Keyword

Hepatocellular carcinoma; Computed tomography; Texture analysis; Recurrence; Disease-free survival; Prognosis

MeSH Terms

Carcinoma, Hepatocellular*
Disease-Free Survival*
Entropy
Filtration
Humans
Kaplan-Meier Estimate
Liver
Prognosis
Recurrence
Weights and Measures

Figure

• 

  Fig. 1 Flowchart of inclusion and exclusion criteria.CT = computed tomography, HCC = hepatocellular carcinoma, PEIT = percutaneous ethanol injection therapy, RFA = radiofrequency ablation, TACE = trans-catheter arterial chemoembolization

• 

  Fig. 2 Contrast-enhanced CT image of HCC in 64-year-old man with texture features.A. CT image showing region of interest drawn around tumor (blue line) and corresponding images of fine, medium, and coarse textures obtained using filter values of 2, 4, and 6, respectively. B. Histogram derived from image showing pixel distribution at filter value of 2.0. SSF = spatial scaling factor

• 

  Fig. 3 Kaplan-Meier curves on arterial-phase CT images showing significant difference in disease-free survival for (A) skewness at spatial scaling factors of 2.0 and (B) 3.0 with p values of < 0.001 and < 0.001, respectively.

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