European Radiology

, Volume 29, Issue 3, pp 1231–1239 | Cite as

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

  • Lucie Brenet Defour
  • Sébastien Mulé
  • Arthur Tenenhaus
  • Tullio Piardi
  • Daniele Sommacale
  • Christine Hoeffel
  • Gérard ThiéfinEmail author



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.


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.


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.


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.


Neoplasm Liver Computed tomography Computer-assisted image analysis Survival 





Hepatocellular carcinoma


Microvascular invasion


Non-alcoholic steatohepatitis


Overall survival


Portal embolisation


Recurrence-free survival


Spatial scale image filtration


Transcatheter arterial chemoembolisation



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. G Thiéfin, Service d’Hépato-Gastroentérologie et de Cancérologie Digestive, Centre Hospitalier Universitaire de Reims, France

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors (A. Tenenhaus, PhD and S. Mulé, MD, PhD) have statistical expertise.

Informed consent

Written informed consent was not required for this study. In accordance with French law, this retrospective study on medical records has been authorised by the Commission Nationale Informatique et Libertés (authorisation number 111 85 23), allowing the computerised management of the medical data at the Reims University Hospital. The participants were informed of the possibility of using the information concerning them, for biomedical research purposes, and had a right of opposition.

Ethical approval

Institutional Review Board approval was not required. In accordance with French law, this retrospective study on medical records has been authorised by the Commission Nationale Informatique et Libertés (authorisation number 111 85 23), allowing the computerised management of the medical data at the Reims University Hospital. The participants were informed of the possibility of using the information concerning them, for biomedical research purposes, and had a right of opposition.


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5679_MOESM1_ESM.docx (79 kb)
ESM 1 (DOCX 79 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Service d’Hépato-Gastroentérologie et de Cancérologie DigestiveCentre Hospitalier Universitaire de ReimsReimsFrance
  2. 2.Service d’Imagerie MédicaleCentre Hospitalier Universitaire de ReimsReimsFrance
  3. 3.Laboratoire des Signaux et Systèmes, CentraleSupélecUniversité Paris-SaclayGif sur YvetteFrance
  4. 4.Service de Chirurgie Générale, Digestive et EndocrineCentre Hospitalier Universitaire de ReimsReimsFrance
  5. 5.CReSTICUniversité de Reims Champagne-ArdenneReimsFrance

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