Role of shear wave sono-elastography (SWE) in characterization of hepatic focal lesions

Mahmoud Abdel-Latif,Amira Ali Rizk,Nehad Fouda,Osama Abdel-Gawad Shiha

doi:10.1186/s43055-020-00186-2

Mahmoud Abdel-Latif, Amira Ali Rizk + Show 2 more

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https://doi.org/10.1186/s43055-020-00186-2

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Abstract

BackgroundFocal liver lesions are considered a major problem during abdominal examinations. Shear wave sono-elastography (SWE) has been demonstrated to be helpful in assessment of liver fibrosis degree.The purpose of this study was to evaluate the role of SWE in characterization of benign and malignant hepatic focal lesions.ResultsSeventy-five (75) patients with variable focal liver lesions (52 malignant and 23 benign) were analyzed by SWE. The stiffness values of surrounding hepatic parenchyma were also measured as a reference for readings of the focal lesion stiffness values. Final diagnosis was achieved by core needle biopsy (in 1 benign and 38 malignant cases) and contrast enhanced CT and MRI (in all cases).Cholangiocarcinoma (CCC) was the stiffest malignant lesion with median stiffness value (35.9 kPa). Focal nodular hyperplasia (FNH) was the stiffest benign lesion (26.7 kPa).The median stiffness value of malignant focal lesions (20.22 kPa) was significantly higher than that of benign focal lesions (10.68 kPa) (P value < 0.001).ROC curve of SWE median stiffness values for differentiation of benign from malignant hepatic focal lesions had AUC = 0.834, and using cut of value 14.165 kPa, yielding 98.1% sensitivity, 78.3% specificity, and 92% accuracy.ConclusionSWE has high accuracy in differentiating benign form malignant liver focal lesions with promising results in individual characterization of some malignant (HCC and CCC) and benign hepatic focal lesion (FNH from other benign lesions).

Highlights

Focal liver lesions are considered a major problem during abdominal examinations
Aim of the work The aim of this study is to evaluate the role of shear wave sono-elastography (SWE) in characterization of benign and malignant hepatic focal lesions
The percent distribution of the 75 focal lesions were the following: (a) 52 malignant focal lesions counting as hepatocellular carcinoma (N = 21) (28%), metastasis (N = 21) {2 Gatstro-intestinal stromal tumor (GIST), 2 bronchogenic carcinoma, 7 breast cancer, 6 colon cancer, 2 prostatic carcinoma, and 2 ovarian carcinoma} (28%), cholangiocarcinoma (N = 4) (5.3%), and lymphoma (N = 6) (8%). (b) 23 benign focal lesions counting as simple cyst (N = 2) (2.7%), hemangioma (N = 6) (8%), hydatid cyst (N = 3) (4%), focal nodular hyperplasia (N = 5) (6.7%), focal fat infiltration (N = 4) (5.3%), and abscess (N = 3) (4%) (Table 5)

Summary

Introduction

Focal liver lesions are considered a major problem during abdominal examinations. Shear wave sonoelastography (SWE) has been demonstrated to be helpful in assessment of liver fibrosis degree. The purpose of this study was to evaluate the role of SWE in characterization of benign and malignant hepatic focal lesions. Focal liver lesions (FLLs) are considered a major problem during abdominal examinations. FLLs are classified as benign or malignant. Benign hepatic lesions can be either solid or cystic, within these types; the subtypes include hemangioma (the most common), hepatic adenoma, focal nodular hyperplasia, focal fatty change, bile duct cysts, and hydatid cysts [2, 3]. Several diagnostic imaging modalities can be used to detect and characterize FLLs as ultrasound, color Doppler, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). More invasive techniques include angiography (seldom used) and percutaneous biopsy [5]

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