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AJR Am J Roentgenol. 2017 Oct;209(4):W211-W220. doi: 10.2214/AJR.16.17398. Epub 2017 Aug 16.

Prediction of Therapeutic Response of Hepatocellular Carcinoma to Transcatheter Arterial Chemoembolization Based on Pretherapeutic Dynamic CT and Textural Findings.

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1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
2 Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul 110-744, Republic of Korea.
3 Department of Radiology, Soonchunhyang Bucheon University Hospital, Bucheon, Republic of Korea.
4 Department of Radiology and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
5 Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.



The objective of our study was to assess the value of CT texture analysis for prediction of therapeutic response of hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization (TACE) with pretherapeutic dynamic CT.


We retrospectively analyzed 132 HCCs in 96 patients treated with TACE who underwent dynamic CT before initial TACE. Imaging findings and arterial enhancement ratios were analyzed. All HCCs were manually segmented, and their texture features were quantitatively extracted using in-house software. CT texture was quantified with 2D and 3D analysis. HCCs were classified as with and without complete response (CR) according to modified Response Evaluation Criteria in Solid Tumors. Predictive factors for CR were assessed with multivariate analysis. Radiologic responses were correlated with time to progression (TTP).


Of the 132 HCCs, CR was achieved in 75 (56.8%). Tumor size, subjective arterial tumor attenuation, and arterial enhancement ratios were significantly associated with CR. On 2D and 3D analysis, tumors with CR showed significantly lower homogeneity and higher mean attenuation, gray-level co-occurrence matrix (GLCM) moments, and CT number percentiles (p < 0.05). On multivariate analysis, higher subjective tumor attenuation (adjusted odds ratio [OR] = 23.35), arterial enhancement ratio (OR = 14.07), GLCM moments (OR = 6.57), smaller tumor size (OR = 17.26), and lower homogeneity (OR = 0.69) were significant predictors of CR compared with incomplete response (p < 0.05). Median survival value for TTP was significantly longer in tumors with CR (p < 0.001).


Pretherapeutic dynamic CT texture analysis can be valuable to predict CR of HCC to TACE. Higher arterial enhancement and GLCM moments, lower homogeneity, and smaller tumor size are significant predictors of CR after TACE.


CT; hepatocellular carcinoma; texture analysis; transcatheter arterial chemoembolization (TACE)

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