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Summary: This study deals with the role of texture analysis as a predictive factor of radiation-induced insufficiency fractures in patients undergoing pelvic radiation. Introduction: This study aims to assess the texture analysis (TA) of computed tomography (CT) simulation scans as a predictive factor of insufficiency fractures (IFs) in patients with pelvic malignancies undergoing radiation therapy (RT). Methods: We performed an analysis of patients undergoing pelvic RT from January 2010 to December 2014, 24 of whom had developed pelvic bone IFs. We analyzed CT-simulation images using ImageJ macro software and selected two regions of interest (ROIs), which are L5 body and the femoral head. TA parameters included mean ( m), standard deviation (SD), skewness (sk), kurtosis ( k), entropy ( e), and uniformity ( u). The IFs patients were compared (1:2 ratio) with controlled patients who had not developed IFs and matched for sex, age, menopausal status, type of tumor, use of chemotherapy, and RT dose. A reliability test of intra- and inter-reader ROI TA reproducibility with the intra-class correlation coefficient (ICC) was performed. Univariate and multivariate analyses (logistic regression) were applied for TA parameters observed both in the IFs and the controlled groups. Results: Inter- and intra-reader ROI TA was highly reproducible (ICC > 0.90). Significant TA parameters on paired t test included L5 m ( p = 0.001), SD ( p = 0.002), k ( p = 0.006), e (p = 0.004), and u ( p = 0.015) and femoral head m ( p < 0.001) and SD ( p = 0.001), whereas on logistic regression analysis, L5 e ( p = 0.003) and u ( p = 0.010) and femoral head m ( p = 0.027), SD ( p = 0.015), and sex ( p = 0.044). Conclusions: In our experience, bone CT TA could be correlated to the risk of radiation-induced IFs. Studies on a large patient series and methodological refinements are warranted. [ABSTRACT FROM AUTHOR]

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