title: Assessment of tumor heterogeneity: an emerging imaging tool for clinical practice?
abstract: BACKGROUND
  Tumor spatial heterogeneity is an important prognostic factor, which may be reflected in medical images
  
  
  METHODS
  Image texture analysis is an approach of quantifying heterogeneity that may not be appreciated by the naked eye. Different methods can be applied including statistical-, model-, and transform-based methods.
  
  
  RESULTS
  Early evidence suggests that texture analysis has the potential to augment diagnosis and characterization as well as improve tumor staging and therapy response assessment in oncological practice.
  
  
  CONCLUSIONS
  This review provides an overview of the application of texture analysis with different imaging modalities, CT, MRI, and PET, to date and describes the technical challenges that have limited its widespread clinical implementation so far. With further efforts to refine its application, image texture analysis has the potential to develop into a valuable clinical tool for oncologic imaging.                                                   TEACHING POINTS                 :                  • Tumor spatial heterogeneity is an important prognostic factor.                                  • Image texture analysis is an approach of quantifying heterogeneity.                                  • Different methods can be applied, including statistical-, model-, and transform-based methods.                                  • Texture analysis could improve the diagnosis, tumor staging, and therapy response assessment.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: Davnall
authors.forename: Connie S P
authors.initials: CS
authors.lastname: Yip
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ljungqvist
authors.forename: Mariyah
authors.initials: M
authors.lastname: Selmi
authors.forename: Francesca
authors.initials: F
authors.lastname: Ng
authors.forename: Bal
authors.initials: B
authors.lastname: Sanghera
authors.forename: Balaji
authors.initials: B
authors.lastname: Ganeshan
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Miles
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Cook
authors.forename: Vicky
authors.initials: V
authors.lastname: Goh