Computed tomography texture analysis to facilitate therapeutic decision making in hepatocellular carcinoma

This study explored the potential of computed tomography (CT) textural feature analysis for the stratification of single large hepatocellular carcinomas (HCCs) > 5 cm, and the subsequent determination of patient suitability for liver resection (LR) or transcatheter arterial chemoembolization (TACE). Wavelet decomposition was performed on portal-phase CT images with three bandwidth responses (filter 0, 1.0, and 1.5). Nine textural features of each filter were extracted from regions of interest. Wavelet-2-H (filter 1.0) in LR and wavelet-2-V (filter 0 and 1.0) in TACE were related to survival. Subsequently, LR and TACE patients were divided based on the wavelet-2-H and wavelet-2-V median at filter 1.0 into two subgroups (+ or -). LR+ patients showed the best survival, followed by LR-, TACE+, and TACE-. We estimated that LR+ patients treated using TACE would exhibit a survival similar to TACE- patients and worse than TACE+ patients, with a severe compromise in overall survival. LR was recommended for TACE- patients, whereas TACE was preferred for LR- and TACE+ patients. Independent of tumor size, CT textural features showed positive and negative correlations with survival after LR and TACE, respectively. Although further validation is needed, texture analysis demonstrated the feasibility of using HCC patient stratification for determining the suitability of LR vs. TACE.