Role of Ultrasound Elastography in Characterization of Focal Solid Hepatic Lesion
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Abstract
Purpose: Analysis of focal solid hepatic lesions by 2D Shear Wave Sono-Elastography and evaluation of its diagnostic accuracy in differentiating benign from malignant lesions.
Methodology: This study included 58 patients all the studied patients were subjected to grey-scale ultrasound and 2D shear wave sono-elastography which were performed on LOGIQTM P9 XDclearTM (GE Healthcare) ultrasound machine with convex transducer (C1-5-D 3.5 MHz).
Results: Sono-elastography showed that most malignant lesions had higher stiffness (median = 33.4 kPa) and showed mixed colour with red foci, whereas most benign lesions had lower stiffness (median = 13.5 kPa) and showed yellow-green color.
Amongst the malignant lesions, hepatocellular carcinomas showed comparatively lower stiffness values (median = 29.25 kPa) than those of metastases and cholangiocarcinomas (median = 36.65 kPa and 39.3 kPa, respectively), and cholangiocarcinoma was established as the stiffest focal solid hepatic lesion.
Among the benign lesions, focal nodular hyperplasia showed higher stiffness (median = 23.7 kPa). Hemangiomas were comparatively softer lesions; however, they showed higher stiffness values (median = 13.3 kPa) as compared to surrounding normal liver parenchyma (median = 4.45 kPa).
Because of the associated diffuse liver fibrosis, hepatocellular carcinomas had the highest stiffness values of background liver parenchyma (median = 11.1 kPa). This, in turn, resulted in a lower lesion/parenchyma stiffness ratio (median = 2.9) in contrast to other malignant lesions (median = 5.7 and 6.3 for metastases and cholangiocarcinoma’s, respectively), with values similar to those seen in cases of benign lesions (median = 2.8).
The threshold cut off value to differentiate benign from malignant solid focal hepatic lesions based on their SWE characteristics was assigned as 15.9 kPa. Using this value with the AUC of 0.9545, the ROC analysis resulted in 100% sensitivity, 90.91% specificity, 97.92% positive predictive value (PPV), 100% negative predictive value (NPV), and 98.28% accuracy.
Conclusion: This study has demonstrated that 2D shear wave sono-elastography is a robust technique and is capable of evaluating stiffness changes in the liver associated with solid focal liver lesions, which helps in distinguishing benign from malignant lesions and also in their sub-categorization, i.e., differentiating focal nodular hyperplasia from hemangioma and differentiating hepatocellular carcinoma from cholangiocarcinoma and metastases, with high sensitivity and accuracy. Thus, it can be added to routine grey-scale sonographic examinations for rapid, cost-effective, non-invasive, and non-contrast assessments to aid the diagnosis and further management.
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References
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