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



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).


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.


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).


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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Fig. 1
Fig. 2



Area under the curve


Confidence interval


Complete response


Computed tomography


Disease-free survival


Eastern Cooperation Oncology Group


Grey-level co-occurrence matrix




Hounsfield units


Intrahepatic cholangiocarcinoma


Interquartile range


Least absolute shrinkage and selection operator


Magnetic resonance imaging


Objective response


Overall survival


Progression-free survival


Partial response


Response Evaluation Criteria In Solid Tumours


Region of interest


Texture analysis


Trans-arterial radioembolisation


Vascular endothelial growth factor


Volume of interest


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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.


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

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Corresponding author

Correspondence to Alessandro Cucchetti.

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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).


• 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).

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  • Cholangiocarcinoma
  • Survival
  • Radiology
  • Cancer