CT texture analysis predicts abdominal aortic aneurysm post-endovascular aortic aneurysm repair progression

The aim of this study is to investigate the role of early postoperative CT texture analysis in aneurysm progression. Ninety-nine patients who had undergone post-endovascular aneurysm repair (EVAR) infra-renal abdominal aortic aneurysm CT serial scans were enrolled from July 2014 to December 2019. The clinical and traditional imaging features were obtained. Aneurysm texture analysis was performed using three methods-the grey-level co-occurrence matrix (GLCM), the grey-level run length matrix (GLRLM), and the grey-level difference method (GLDM). A multilayer perceptron neural network was applied as a classifier, and receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) analysis were employed to illustrate the classification performance. No difference was found in the morphological and clinical features between the expansion (+) and (-) groups. GLCM yielded the best performance with an accuracy of 85.17% and an AUC of 0.90, followed by GLRLM with an accuracy of 87.23% and an AUC of 0.8615, and GLDM with an accuracy of 86.09% and an AUC of 0.8313. All three texture analyses showed superior predictive ability over clinical risk factors (accuracy: 69.41%; AUC: 0.6649), conventional imaging features (accuracy: 69.02%; AUC: 0.6747), and combined (accuracy: 75.29%; AUC: 0.7249). Early post-EVAR arterial phase-derived aneurysm texture analysis is a better predictor of later aneurysm expansion than clinical factors and traditional imaging evaluation combined.