Abstract
Background and Aims: Elastography can provide information regarding tissue stiffness (TS). This study aimed to analyze the elastographic features of hepatocellular carcinoma (HCC) and the factors that influence intratumoral elastographic variability in patients with liver cirrhosis. Methods: This prospective study included 115 patients with liver cirrhosis and hepatocellular carcinoma evaluated between June 2016–November 2019. A total of 88 HCC nodules visualized in conventional abdominal ultrasound (US) met the inclusion criteria and underwent elastographic evaluation. Elastographic measurements (EM) were performed in HCC and liver parenchyma using VTQ (Virtual Touch Quantification), a point shear wave elastography (pSWE) technique. In all patients, we performed contrast-enhanced ultrasound (CEUS), and the final diagnosis of HCC was established by contrast-enhanced-CT or contrast-enhanced-MRI. Results: The mean VTQ values in HCCs were 2.16 ± 0.75 m/s. TS was significantly lower in HCCs than in the surrounding liver parenchyma 2.16 ± 0.75 m/s vs. 2.78 ± 0.92 (p < 0.001). We did not find significant differences between the first five and the last five EM, and the intra-observer reproducibility was excellent ICC: 0.902 (95% CI: 0.87–0.950). However, the tumor size, heterogeneity, and depth correlated with higher intralesional stiffness variability (p < 0.001). Conclusions: VTQ brings additional information for HCC characterization. Intra-observer reproducibility for both HCC and liver parenchyma was excellent. Knowing the stiffness of HCC’s might endorse an algorithm-based approach towards focal liver lesions (FLLs) in liver cirrhosis.
Highlights
Bi-annual ultrasound (US) surveillance is recommended worldwide as a screening tool for hepatocellular carcinoma (HCC) in patients with cirrhosis by all major hepatology societies [1,2,3,4]
US are available on almost all US machines, but newer devices have the additional option of elastography and contrast-enhanced ultrasound (CEUS), providing more information, a faster and more accurate diagnosis, usually at the point of care
The US elastography techniques have as fundamental principle measurement of minimal displacements in the tissue caused by mechanical compression or by an enforced acoustic impulse which acts as a wavefront [9]
Summary
Bi-annual ultrasound (US) surveillance is recommended worldwide as a screening tool for HCC in patients with cirrhosis by all major hepatology societies [1,2,3,4]. Conventional US is a widely available, non-invasive, risk-free, inexpensive imaging tool that provides a realtime assessment of the liver. Having all these advantages, US is the most commonly used tool in the diagnostic algorithm of liver disease. US are available on almost all US machines, but newer devices have the additional option of elastography and contrast-enhanced ultrasound (CEUS), providing more information, a faster and more accurate diagnosis, usually at the point of care. This approach shortens the diagnostic algorithm duration and can avoid further long-waiting procedures such as CT/MRI and/or liver biopsy. The factors that influence intratumoral elastographic variability in patients with liver cirrhosis
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