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Radiomics of cholangiocarcinoma on pretreatment CT can identify patients who would best respond to radioembolisation

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Abstract

Objectives

Results after trans-arterial radioembolisation (TARE) for intrahepatic cholangiocarcinoma (iCC) depend on the architecture of the tumour. This latter can be quantified through computed tomography (CT) texture analysis. The aims of the present study were to analyse relationships between CT textural features prior to TARE and objective response (OR), progression-free survival (PFS), and overall survival (OS).

Methods

Texture analysis was retrospectively applied to 55 pre-TARE CT scans of iCCs, focusing attention on the histogram-based features and the grey-level co-occurrence matrix (GLCM). Texture features were harmonised using the ComBat procedure. Objective response was assessed using the Response Evaluation Criteria In Solid Tumours 1.1. The least absolute shrinkage and selection operator (LASSO) method was applied to select the most useful textural features related to OR.

Results

Of the 55 patients, 53 had post-TARE imaging available, showing OR in 56.6% of cases. Texture analysis showed that iCCs showing OR after TARE had a higher uptake of iodine contrast in the arterial phase (higher mean histogram values, p < 0.001) and more homogeneous distribution (lower kurtosis, p = 0.043; GLCM contrast, p = 0.004; GLCM dissimilarity, p = 0.005, and higher GLCM homogeneity, p = 0.005; and GLCM correlation p = 0.030) at the pre-TARE CT scan. A favourable radiomic signature was calculated and observed in 15 of the 55 patients. The median PFS of these 15 patients was 12.1 months and that of the remaining 40 patients was 5.1 months (p = 0.008).

Conclusions

Texture analysis of pre-TARE CT scans can quantify vascularisation and homogeneity of iCC architecture, providing clinical information useful in identifying ideal TARE candidates.

Key Points

• Hypervascular tumours with a more homogeneous uptake of iodine contrast in the arterial phase were those most likely to be effectively treated by TARE.

• The arterial phase was observed to be the best acquisition phase for providing information regarding the “sensitivity” of the tumour to TARE.

• Patients with favourable radiomic signature showed a median progression-free survival of 12.1 months versus 5.1 months of patients with an unfavourable signature (p = 0.008).

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Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

CR:

Complete response

CT:

Computed tomography

DFS:

Disease-free survival

ECOG:

Eastern Cooperation Oncology Group

GLCM:

Grey-level co-occurrence matrix

Gy:

Grey

HU:

Hounsfield units

iCC:

Intrahepatic cholangiocarcinoma

IQR:

Interquartile range

LASSO:

Least absolute shrinkage and selection operator

MRI:

Magnetic resonance imaging

OR:

Objective response

OS:

Overall survival

PFS:

Progression-free survival

PR:

Partial response

RECIST:

Response Evaluation Criteria In Solid Tumours

ROI:

Region of interest

TA:

Texture analysis

TARE:

Trans-arterial radioembolisation

VEGF:

Vascular endothelial growth factor

VOI:

Volume of interest

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Acknowledgements

The authors thank Fanny Orlhac of the Imagerie Moléculaire In Vivo, CEA-SHFJ, INSERM, CNRS, Université Paris-Sud, Université Paris-Saclay, Orsay, France, for her help in the ComBat procedure.

Funding

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

Author information

Authors and Affiliations

  1. Radiology Unit, Department of Specialized, Diagnostic and Experimental Medicine – DIMES, S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy

    Cristina Mosconi, Antonio Bruno, Alberta Cappelli, Caterina De Benedittis, Lorenza Parini, Francesco Modestino, Giuliano Peta & Rita Golfieri

  2. Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy

    Alessandro Cucchetti

  3. Morgagni – Pierantoni Hospital, Forlì, Italy

    Alessandro Cucchetti

  4. Interventional Radiology Unit, Pisa University Hospital, Pisa, Italy

    Irene Bargellini, Giulia Lorenzoni, Francesco Paolo Tarantino & Roberto Cioni

  5. Division of Semeiotic, Department of Medical and Surgical Sciences- DIMEC; S.Orsola - Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy

    Annagiulia Gramenzi

  6. Medical Physics Unit, Radiology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy

    Vincenzina Pettinato

Authors
  1. Cristina Mosconi
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  2. Alessandro Cucchetti
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  3. Antonio Bruno
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  4. Alberta Cappelli
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  5. Irene Bargellini
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  6. Caterina De Benedittis
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  7. Giulia Lorenzoni
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  8. Annagiulia Gramenzi
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  9. Francesco Paolo Tarantino
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  10. Lorenza Parini
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  11. Vincenzina Pettinato
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  12. Francesco Modestino
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  13. Giuliano Peta
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  14. Roberto Cioni
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  15. Rita Golfieri
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Corresponding author

Correspondence to Alessandro Cucchetti.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Prof. Rita Golfieri.

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

One of the authors has significant statistical expertise. Prof. Alessandro Cucchetti kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The present study fulfils the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data (GDP regulation).

  1. 1).

    All the data subject in the present study has given consent to the processing of his or her personal data for one or more specific purposes (art 6.1.a).

  2. 2).

    Personal data were processed lawfully, fairly and in a transparent manner in relation to the data subject (art. 5. 1.a).

  3. 3).

    Data were collected for specified, explicit, and legitimate purposes in the public interest, scientific, or historical research (art. 5.1.b, art. 9.2.j, and art.89).

  4. 4).

    Additional purposes or statistical purposes were not incompatible with the initial purposes (art.89).

  5. 5).

    No “biometric data” resulting from specific technical processing relating to the physical, physiological, or behavioural characteristics of a natural person, which allow or confirm the unique identification of that natural person, such as facial images or dactyloscopic data, were collected (art 4.14).

Methodology

• Retrospective

• Observational

• Multicentre study

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Mosconi, C., Cucchetti, A., Bruno, A. et al. Radiomics of cholangiocarcinoma on pretreatment CT can identify patients who would best respond to radioembolisation. Eur Radiol 30, 4534–4544 (2020). https://doi.org/10.1007/s00330-020-06795-9

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  • DOI: https://doi.org/10.1007/s00330-020-06795-9

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