Abdominal Radiology

, Volume 42, Issue 8, pp 2069–2078 | Cite as

Texture analysis of the liver at MDCT for assessing hepatic fibrosis

  • Meghan G. LubnerEmail author
  • Kyle Malecki
  • John Kloke
  • Balaji Ganeshan
  • Perry J. Pickhardt



To evaluate CT texture analysis (CTTA) for staging of hepatic fibrosis (stages F0–F4)


Quantitative texture analysis (QTA) of the liver was performed on abdominal MDCT scans using commercially available software (TexRAD), which uses a filtration-histogram statistic-based technique. Single-slice ROI measurements of the total liver, Couinaud segments IV-VIII, and segments I–III were obtained. CTTA parameters were correlated against fibrosis stage (F0–F4), with biopsy performed within one year for all cases with intermediate fibrosis (F1–F3).


The study cohort consisted of 289 adults (158M/131W; mean age, 51 years), including healthy controls (F0, n = 77), and patients with increasing stages of fibrosis (F1, n = 42; F2 n = 37; F3 n = 53; F4 n = 80). Mean gray-level intensity increased with fibrosis stage, demonstrating an ROC AUC of 0.78 at medium filtration for F0 vs F1-4, with sensitivity and specificity of 74% and 74% at cutoff 0.18. For significant fibrosis (≥F2), mean showed AUCs ranging from 0.71–0.73 across medium- and coarse- filtered textures with sensitivity and specificity of 71% and 68% at cutoff of 0.3, with similar performance also observed for advanced fibrosis (≥F3). Entropy showed a similar trend. Conversely, kurtosis and skewness decreased with increasing fibrosis, particularly in cirrhotic patients. For cirrhosis (≥F4), kurtosis and skewness showed AUCs of 0.86 and 0.87, respectively, at coarse-filtered scale, with skewness showing a sensitivity and specificity of 84% and 75% at cutoff of 1.3.


CTTA may be helpful in detecting the presence of hepatic fibrosis and discriminating between stages of fibrosis, particularly at advanced levels.


CT texture analysis Hepatic fibrosis Liver disease Cirrhosis 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

Dr. Lubner receives grant funding from Philips and Ethicon. Dr. Ganeshan is Director and part-employed by TexRAD Ltd (part of Feedback Plc, Cambridge, UK). Dr. Pickhardt is co-founder of VirtuoCTC and shareholder in Cellectar Biosciences and SHINE. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required

Informed consent

The need for informed consent was waived by the IRB.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Meghan G. Lubner
    • 1
    Email author
  • Kyle Malecki
    • 1
  • John Kloke
    • 1
  • Balaji Ganeshan
    • 2
  • Perry J. Pickhardt
    • 1
  1. 1.Department of Radiology, School of Medicine and Public HealthUniversity of WisconsinMadisonUSA
  2. 2.Institute of Nuclear MedicineUniversity College LondonLondonUK

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