Presence of microvascular invasion (MVI) indicates poorer prognosis post-curative resection of hepatocellular carcinoma (HCC), with an increased chance of tumour recurrence. By present standards, MVI can only be diagnosed post-operatively on histopathology.

Texture analysis potentially allows identification of patients who are considered ‘high risk’ through analysis of pre-operative magnetic resonance imaging (MRI) studies. These findings may or may not be readily apparent to the human eye, thus the need for an analytic software. This will in turn allow for better patient selection, improved individualised therapy (such as extended surgical margins or adjuvant therapy) and pre-operative prognostication.

To evaluate the accuracy of texture analysis on pre-operative MRI in predicting MVI in HCC.

We recruited patients who underwent hepatectomy. Both qualitative (performed by radiologists) and quantitative data (performed by software) were obtained. Radiomics texture parameters were extracted based on the largest cross-sectional area of each tumor and analysed using MaZda software. Final histology of the tumour was used as ground truth.

Texture analysis of tumours on pre-operative MRI can predict presence of MVI in HCC with accuracies of up to 87.8%.

Texture analysis of HCC performed on pre-operative MR images can accurately predict the presence of MVI with an accuracy of up to 87.8%. It has potential to be incorporated into clinical routine as a reliable tool for making pre-operative treatment decisions. Larger studies should be performed to validate the texture parameters and its value over qualitative visual analysis.

This study demonstrates the utility of texture analysis on pre-operative MRI to potentially impact clinical management in patients with surgically resectable hepatocellular carcinoma.