Can the computed tomography texture analysis of colorectal liver metastases predict the response to first-line cytotoxic chemotherapy?

BACKGROUND: Artificial intelligence in radiology has the potential to assist with the diagnosis, prognostication and therapeutic response prediction of various cancers. A few studies have reported that texture analysis can be helpful in predicting the response to chemotherapy for colorectal liver metastases, however, the results have varied. Necrotic metastases were not clearly excluded in these studies and in most studies the full range of texture analysis features were not evaluated. This study was designed to determine if the computed tomography (CT) texture analysis results of non-necrotic colorectal liver metastases differ from previous reports. A larger range of texture features were also evaluated to identify potential new biomarkers. AIM: To identify potential new imaging biomarkers with CT texture analysis which can predict the response to first-line cytotoxic chemotherapy in non-necrotic colorectal liver metastases (CRLMs). METHODS: Patients who presented with CRLMs from 2012 to 2020 were retrospectively selected on the institutional radiology information system of our private radiology practice. The inclusion criteria were non-necrotic CRLMs with a minimum size of 10 mm (diagnosed on archived 1.25 mm portal venous phase CT scans) which were treated with standard first-line cytotoxic chemotherapy (FOLFOX, FOLFIRI, FOLFOXIRI, CAPE-OX, CAPE-IRI or capecitabine). The final study cohort consisted of 29 patients. The treatment response of the CRLMs was classified according to the RECIST 1.1 criteria. By means of CT texture analysis, various first and second order texture features were extracted from a single non-necrotic target CRLM in each responding and non-responding patient. Associations between features and response to chemotherapy were assessed by logistic regression models. The prognostic accuracy of selected features was evaluated by using the area under the curve. RESULTS: There were 15 responders (partial response) and 14 non-responders (7 stable and 7 with progressive disease). The responders presented with a higher number of CRLMs (P = 0.05). In univariable analysis, eight texture features of the responding CRLMs were associated with treatment response, but due to strong correlations among some of the features, only two features, namely minimum histogram gradient intensity and long run low grey level emphasis, were included in the multiple analysis. The area under the receiver operating characteristic curve of the multiple model was 0.80 (95%CI: 0.64 to 0.96), with a sensitivity of 0.73 (95%CI: 0.48 to 0.89) and a specificity of 0.79 (95%CI: 0.52 to 0.92). CONCLUSION: Eight first and second order texture features, but particularly minimum histogram gradient intensity and long run low grey level emphasis are significantly correlated with treatment response in non-necrotic CRLMs.