Hepatocellular carcinoma: CT texture analysis as a predictor of survival after surgical resection

Objectives: To determine whether image texture parameters analysed on pre-operative contrast-enhanced computed tomography (CT) can predict overall survival and recurrence-free survival in patients with hepatocellular carcinoma (HCC) treated by surgical resection. Methods: We retrospectively included all patients operated for HCC who had liver contrast-enhanced CT within 3 months prior to treatment in our centre between 2010 and 2015. The following texture parameters were evaluated on late-arterial and portal-venous phases: mean grey-level, standard deviation, kurtosis, skewness and entropy. Measurements were made before and after spatial filtration at different anatomical scales (SSF) ranging from 2 (fine texture) to 6 (coarse texture). Lasso penalised Cox regression analyses were performed to identify independent predictors of overall survival and recurrence-free survival. Results: Forty-seven patients were included. Median follow-up time was 345 days (interquartile range [IQR], 176–569). Nineteen patients had a recurrence at a median time of 190 days (IQR, 141–274) and 13 died at a median time of 274 days (IQR, 96–411). At arterial CT phase, kurtosis at SSF = 4 (hazard ratio [95% confidence interval] = 3.23 [1.35–7.71] p = 0.0084) was independent predictor of overall survival. At portal-venous phase, skewness without filtration (HR [CI 95%] = 353.44 [1.31–95102.23], p = 0.039), at SSF2 scale (HR [CI 95%] = 438.73 [2.44–78968.25], p = 0.022) and SSF3 (HR [CI 95%] = 14.43 [1.38–150.51], p = 0.026) were independently associated with overall survival. No textural feature was identified as predictor of recurrence-free survival. Conclusions: In patients with resectable HCC, portal venous phase–derived CT skewness is significantly associated with overall survival and may potentially become a useful tool to select the best candidates for resection. Key Points: • HCC heterogeneity as evaluated by texture analysis of contrast-enhanced CT images may predict overall survival in patients treated by surgical resection. • Among texture parameters, skewness assessed at different anatomical scales at portal-venous phase CT is an independent predictor of overall survival after resection. • In patients with HCC, CT texture analysis may have the potential to become a useful tool to select the best candidates for resection.