Radiofrequency ablation of HCC: CT texture analysis of the ablated area to predict local recurrence

Purpose: To investigate the role of CT texture analysis in the risk assessment of local recurrence after HCC ablation. Material and Methods: Patients treated with percutaneous liver ablation were retrospectively enrolled between January 2015 and December 2018. CT texture analysis was performed both on the core and borders of the ablation area 1–2 months after procedure. Tumors were grouped according to the onset of local recurrence at follow-up (persistence, recurrence-free, short- or longterm recurrence). ANOVA/Kruskal–Wallis tests and a multivariable Cox regression model were used to assess differences in texture parameters and which parameters were predictive of recurrence risk. Results: 263 tumors were treated in 200 patients; 98 patients (72±9 years, 83 men) met the inclusion criteria for a total of 151 HCCs considered independently. 68 HCCs reported no disease recurrence, 32 persistent disease, 19 short-term and 32 long-term recurrence. Median follow-up was 121 [range: 29–1680] days. VenSkewness (p=0.02) and VenKurtosis (p=0.01) of the ablation core were predictive of short-term recurrence. VenHUmean (p=0.02) and VenGLRLM_HGRE (p=0.02) of the core were independent predictors of tumor recurrence. ArtEntropy of ablation border predicted the recurrence risk (p=0.04) and values higher than 3.71 reported an increased recurrence incidence (p=0.05). ArtHUstd (p=0.01), LateHUmean (p=0.04), LateGLRLM_HGRE (p=.003), LateGLZLM_HGZE (p<0.01) and LateGLZLM_SZHGE (p=.02) of ablation border were independent predictors of local recurrence risk. Conclusion: CT texture analysis of the ablation area performed at 1–2-month follow-up allows to estimate the risk of local recurrence of HCC treated by radiofrequency ablation; one may be able to modify clinical–therapeutic decisions accordingly.