Radiomic analysis of living hepatocellular carcinoma, both in vivo and ex vivo

Normothermic perfusion systems enable ex vivo study of drug metabolism and personalized treatment efficacy in resected tumors. However, the consistency of quantitative imaging biomarkers between in vivo and perfused ex vivo settings remains unexplored. We present the first radiomic analysis comparing hepatocellular carcinoma (HCC) tumors imaged both preoperatively and on a normothermic perfusion system. Using paired computed tomography (CT) scans of five HCC tumors, we evaluated shape, texture, and intensity features for consistency using the Wilcoxon Signed-Rank test. Shape features demonstrated consistency across imaging conditions, while texture and intensity features showed variability. This study aims to present a framework and possible opportunities to investigate the feasibility of translating findings and observations associated with radiomic features from one setting to the other, allowing inferences to be drawn about the value of various types of treatment.