Morphomic Signatures Derived from Computed Tomography Predict Hepatocellular Carcinoma Occurrence in Cirrhotic Patients

Dig Dis Sci. 2020 Jul;65(7):2130-2139. doi: 10.1007/s10620-019-05915-w. Epub 2019 Nov 2.


Background and aims: Computed tomography (CT) provides scans of the human body from which digitized features can be extracted. The aim of this study was to examine the role of these digital biomarkers for predicting subsequent occurrence of hepatocellular carcinoma (HCC) in cirrhotic patients.

Methods: A cohort of 269 patients with cirrhosis were recruited and prospectively followed for the occurrence of HCC in Taiwan. CT scans were retrospectively retrieved and computationally processed using analytic morphomics. A predictive score was constructed using Cox regression and the generalized iterative modeling method, maximizing the log likelihood of the time to HCC development. An independent cohort of 274 patients from University of Michigan was utilized to examine the predictive validity of this score in a Western population.

Results: Of the 27 digitized features at the 12th thoracic vertebral level, six features were significantly associated with HCC occurrence. Two digitized features (fascia eccentricity and the bone mineral density) were able to stratify patients into high- and low-risk groups with distinct cumulative incidence of HCC in both the training and validation cohorts (P = 0.015 and 0.044, respectively). When the two digitized features were tested in the Michigan cohort, only bone mineral density remained an effective predictor.

Conclusion: Digitized features derived from the CT were effective in predicting subsequent occurrence of HCC in cirrhosis patients. The bone mineral density measured on CT was an effective predictor for patients in both Taiwan and USA.

Keywords: Bone mineral density; Fascia eccentricity; Prognosis; Retrospective–prospective design.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Bone Density
  • Bone and Bones / diagnostic imaging
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / metabolism
  • Fascia / diagnostic imaging
  • Female
  • Hepatitis B, Chronic / complications
  • Hepatitis C, Chronic / complications
  • Humans
  • Image Processing, Computer-Assisted
  • Incidence
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / metabolism
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / metabolism
  • Male
  • Michigan / epidemiology
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging
  • Paraspinal Muscles / diagnostic imaging
  • Proportional Hazards Models
  • Prospective Studies
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Taiwan / epidemiology
  • Tomography, X-Ray Computed
  • alpha-Fetoproteins / metabolism


  • alpha-Fetoproteins