Abdominal Radiology

, Volume 44, Issue 7, pp 2346–2356 | Cite as

Feasibility of using computed tomography texture analysis parameters as imaging biomarkers for predicting risk grade of gastrointestinal stromal tumors: comparison with visual inspection

  • In Young Choi
  • Suk Keu YeomEmail author
  • Jaehyung Cha
  • Sang Hoon Cha
  • Seung Hwa Lee
  • Hwan Hoon Chung
  • Chang Min Lee
  • Jungwoo Choi
Hollow Organ GI



To evaluate the feasibility of using computed tomography texture analysis (CTTA) parameters for predicting malignant risk grade and mitosis index of gastrointestinal stromal tumors (GISTs), compared with visual inspection.

Method and materials

CTTA was performed on portal phase CT images of 145 surgically confirmed GISTs (mean size: 42.9 ± 37.5 mm), using TexRAD software. Mean, standard deviation, entropy, mean of positive pixels (MPP), skewness, and kurtosis of CTTA parameters, on spatial scaling factor (SSF), 2–6 were compared by risk grade, mitosis rate, and the presence or absence of necrosis on visual inspection. CTTA parameters were correlated with risk grade. Diagnostic performance was evaluated with receiver operating characteristic curve analysis. Enhancement pattern, necrosis, heterogeneity, calcification, growth pattern, and mucosal ulceration were subjectively evaluated by two observers.


Three to four parameters at different scales were significantly different according to the risk grade, mitosis rate, and the presence or absence of necrosis (p < 0.041). MPP at fine or medium scale (r = − 0.547 to − 393) and kurtosis at coarse scale (r = 0.424–0.454) correlated significantly with risk grade (p < 0.001). HG-GIST was best differentiated from LG-GIST by MPP at SSF 2 (AUC, 0.782), and kurtosis at SSF 4 (AUC, 0.779) (all p < 0.001). CT features predictive of HG-GIST were density lower than or equal to that of the erector spinae muscles on enhanced images (OR 2.1; p = 0.037; AUC, 0.59), necrosis (OR, 6.1; p < 0.001; AUC, 0.70), heterogeneity (OR, 4.3; p < 0.001; AUC, 0.67), and mucosal ulceration (OR, 3.3; p = 0.002; AUC, 0.62).


Using TexRAD, MPP and kurtosis are feasible in predicting risk grade and mitosis index of GISTs. CTTA demonstrated meaningful accuracy in preoperative risk stratification of GISTs.


Computed tomography texture analysis Gastrointestinal stromal tumor Mitosis rate Risk stratification 



This research was supported by a Korea University Ansan Hospital Grant (O1801331) and Korea University Grant (K1422331).

Compliance with ethical standards

Conflicts of interest

The scientific guarantor of this publication is Suk Keu Yeom. 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. The authors state that this work has not received any funding.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Korea University Ansan HospitalKorea University College of MedicineAnsanRepublic of Korea
  2. 2.Department of Biostatistics, Korea University Ansan HospitalKorea University College of MedicineAnsanRepublic of Korea
  3. 3.Department of Surgery, Korea University Ansan HospitalKorea University College of MedicineAnsanRepublic of Korea
  4. 4.Department of Pathology, Korea University Ansan HospitalKorea University College of MedicineAnsanRepublic of Korea

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