Shear Wave Dispersion Imaging for the Characterization of Focal Liver Lesions – A Pilot study

2021 ◽  
Author(s):  
Daniel Jesper ◽  
Steffen Fiedler ◽  
Daniel Klett ◽  
Maximilian J Waldner ◽  
Barbara Schellhaas ◽  
...  
Keyword(s):  
Shear Wave ◽  
Wave Dispersion ◽  
Liver Parenchyma ◽  
Benign Tumors ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Shear Wave Speed ◽  
Lower Shear ◽  
Malignant Lesions

Abstract Purpose Shear wave dispersion imaging is a novel ultrasound-based technique, which analyzes the speed of different shear wave components depending on their frequency. The dispersion of shear wave speed correlates with the viscosity of the liver parenchyma. The aim of this prospective study was to evaluate the use of shear wave dispersion imaging in focal liver lesions in the non-cirrhotic liver. Methods Patients with unclear focal liver lesions in B-mode ultrasound were prospectively assigned to shear wave dispersion imaging (m/s/kHz). Measurements were conducted within the lesion and in the liver parenchyma of the right liver lobe using an intercostal window. Histology and contrast-enhanced ultrasound served as the reference for the characterization of the lesions. Results Out of 46 patients included in this study, 24 had liver metastases and 22 had benign liver lesions. Benign lesions consisted mostly of hemangiomas (n=12) and focal nodular hyperplasia (n=8). Malignant lesions showed significantly lower shear wave dispersion (13.0±2.45 m/s/kHz) compared to benign tumors (15.2±2.74 m/s/kHz, p<0.01). In further subgroup analysis, the difference was significant for hemangiomas (15.32±2.42 m/s/kHz, p=0.04) but not for FNHs (14.98±3.36 m/s/kHz, p=0.38). The dispersion of reference liver parenchyma did not differ significantly between the groups (p=0.54). Conclusion The quantification of viscosity by shear wave dispersion is a new parameter for the characterization of focal liver lesions with higher dispersion values in hemangiomas and lower dispersion values in metastases. However, it cannot differentiate reliably between benign and malignant lesions.

Preliminary Clinical Experience with Shear Wave Dispersion Imaging for Liver Viscosity in Preoperative Diagnosis of Focal Liver Lesions

2020 ◽  
Vol 58 (09) ◽  
pp. 847-854
Author(s):  
Yi Dong ◽  
Yijie Qiu ◽  
Qi Zhang ◽  
Daohui Yang ◽  
Lingyun Yu ◽  
...  
Keyword(s):  
Shear Wave ◽  
Liver Tumors ◽  
Area Under The Curve ◽  
Wave Dispersion ◽  
Liver Parenchyma ◽  
Final Diagnosis ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Medical Systems ◽  
The Right

Abstract Background The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. Methods Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21–74 years, 37 males) with 58 FLLs located on the right lobe of liver were prospectively studied. The Aplio i900 series diagnostic ultrasound system (Canon Medical systems) equipped with a curvilinear PV1-475BX transducer (1–8 MHz) was used. SWD slope and viscosity measurements were expressed as mean ± standard deviation for both liver tumors and background liver parenchyma. Histopathological results after surgery were regarded as the gold standard for diagnosis. Results Final diagnosis included 40 cases of malignant and 18 cases of benign FLLs. The mean viscosity value were 14.78 ± 1.86 m/s/kHz for hepatocellular carcinoma (n = 30), 14.81 ± 2.35 m/s/kHz for liver metastasis lesions (n = 10), 13.23 ± 1.31 m/s/kHz for hemangioma (n = 13), and 13.67 ± 2.72 m/s/kHz for focal nodular hyperplasia (n = 5). Malignant FLLs showed higher mean viscosity values (14.79 ± 3.15 m/s/KHz) than benign FLLs (13.36 ± 2.76 m/s/KHz) (p < 0.05). The best performing cut-off value of lesion viscosity was 13.15 m/s/kHz (sensitivity 83.3 %; specificity 56.5 %; area under the curve (AUC) 0.71) for malignancy) (p < 0.05). Conclusions The analysis of SWD slope and liver viscosity parameters provide additional viscoelastic information about FLLs before operation.

scholarly journals Diagnostic value of Virtual Touch Quantification (VTQ®) for differentiation of hemangiomas from malignant focal liver lesions

2019 ◽  
Vol 21 (4) ◽  
pp. 371 ◽  
Author(s):  
Giovanni Galati ◽  
Antonio De Vincentis ◽  
Paolo Gallo ◽  
Alessandro Guidi ◽  
Umberto Vespasiani-Gentilucci ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Shear Wave Velocity ◽  
Abdominal Ultrasound ◽  
Diagnostic Value ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Lower Shear ◽  
Hepatocellular Carcinomas ◽  
Significant Difference ◽  
Malignant Lesions

Aim: To evaluate the diagnostic value of Virtual Touch Quantification (VTQ®) for characterizing benign vs. malignant focal liver lesions (FLLs).Material and methods: From January 2015 to January 2016 all consecutive FLLs visualized during a conventional abdominal ultrasound (US), underwent VTQ® evaluation, taking five measurements of both the lesion and the surrounding parenchyma.Results: We studied 119 FLLs, consisting of 52 hemangiomas (HEs), 39 hepatocellular carcinomas (HCCs), and 28 liver metastases (METs). HEs showed a significantly lower shear wave velocity (SWV) values compared to malignant FLLs (HEs SWV median value 1.34 m/sec, IQR 0.9; malignant lesions SWV median value 2.69 m/sec, IQR 1.6; p<0.001). Moreover, a nodule-to-parenchyma SWV ratio showed a significant difference in HEs and METs (p<0.001) but not in HCCs (p=0.03). SWV values were able to correctly differentiate malignant lesions with c-statistics of 0.82 (95 % CI 0.74- 0.90) and sensitivity of 74.6%/specificity of 80.7% at a cut-off of 2 m/sec.Conclusions: Our results suggest that VTQ® is able to distinguish HEs from malignant lesions (HCCs and METs) at a SWV cut-off of 2 m/sec.

scholarly journals The Use of Contrast-Enhanced Ultrasonography for the Characterization of Focal Liver Lesions

2017 ◽  
Vol 33 (6) ◽  
pp. 500-511
Author(s):  
Jennifer E. Bagley ◽  
Dennis E. Paul ◽  
Sutton Halferty ◽  
Dora DiGiacinto
Keyword(s):  
High Sensitivity ◽  
Diagnostic Process ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Benign Lesions ◽  
Underlying Liver Disease ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography ◽  
Malignant Lesions

Focal liver lesions often occur with or without an underlying liver disease. Contrast-enhanced ultrasonography can aid in characterizing liver lesions, potentially avoiding biopsy and computed tomography procedures. Contrast-enhanced ultrasonography has a high sensitivity and specificity for differentiating characteristics of liver lesions compared with noncontrast sonography. The different contrast characteristics aid in differentiating benign and malignant lesions. Malignant lesions tend to have washout of contrast in the venous phases, whereas benign lesions have hyperenhancement during the venous phases. Therefore, contrast-enhanced ultrasonography should be considered an essential component of the diagnostic process for diagnosing and following focal liver lesions.

scholarly journals Aim: To investigate the value of ElastPQ measurement for differential diagnosis of benign and malignant focal liver lesions (FLLs) by using histologic results as a reference standard. Material and methods: A total of 154 patients were included. ElastPQ measurement was performed for each lesion in which the shear wave speed (SWS) was measured. The difference in SWS and SWS ratio of FLL to surrounding liver were evaluated, and the cut off value was investigated. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance. Histology as a gold standard was obtained by surgery in all patients. Results: A total of 154 lesions including 129 (83.7 %) malignant FLLs and 25 (16.3 %) benign ones were analysed. The SWS of malignant and benign FLLs was significantly different, 2.77±0.68 m/s and 1.57±0.55 m/s (p<0.05). The SWS ratio of each FLL to surrounding liver parenchyma was 2.23±0.49 for malignant and 1.14±0.36 for benign FLLs (p<0.05). The cut off value for differential diagnosis was 2.06 m/s for SWS and 1.67 for SWS ratio. Conclusions: ElastPQ measurement provides reliable quantitative stiffness information of FLLs and may be helpful in the differential diagnosis between malignant and benign FLLs.

2017 ◽  
Vol 19 (3) ◽  
pp. 259 ◽  
Author(s):  
Yi Dong ◽  
Wen-Ping Wang ◽  
Yadan Xu ◽  
Jiaying Cao ◽  
Feng Mao ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Gold Standard ◽  
Diagnostic Performance ◽  
Wave Speed ◽  
Operating Characteristic ◽  
Liver Parenchyma ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Shear Wave Speed ◽  
The Difference

Aim: To investigate the value of ElastPQ measurement for differential diagnosis of benign and malignant focal liver lesions (FLLs) by using histologic results as a reference standard.Material and methods: A total of 154 patients were included. ElastPQ measurement was performed for each lesion in which the shear wave speed (SWS) was measured. The difference in SWS and SWS ratio of FLL to surrounding liver were evaluated, and the cut off value was investigated. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance. Histology as a gold standard was obtained by surgery in all patients.Results: A total of 154 lesions including 129 (83.7 %) malignant FLLs and 25 (16.3 %) benign ones were analysed. The SWS of malignant and benign FLLs was significantly different, 2.77±0.68 m/s and 1.57±0.55 m/s (p<0.05). The SWS ratio of each FLL to surrounding liver parenchyma was 2.23±0.49 for malignant and 1.14±0.36 for benign FLLs (p<0.05). The cut off value for differential diagnosis was 2.06 m/s for SWS and 1.67 for SWS ratio.Conclusions: ElastPQ measurement provides reliable quantitative stiffness information of FLLs and may be helpful in the differential diagnosis between malignant and benign FLLs.

Intraoperative Shear Wave Elastography vs. Contrast-Enhanced Ultrasound for the Characterization and Differentiation of Focal Liver Lesions to Optimize Liver Tumor Surgery

2018 ◽  
Vol 40 (02) ◽  
pp. 205-211 ◽  
Author(s):  
Natascha da Silva ◽  
Matthias Hornung ◽  
Lukas Beyer ◽  
Christina Hackl ◽  
Stefan Brunner ◽  
...  
Keyword(s):  
Shear Wave ◽  
Liver Surgery ◽  
Sulfur Hexafluoride ◽  
Tumor Resection ◽  
Shear Wave Elastography ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Shear Wave Speed ◽  
Contrast Enhanced

Abstract Purpose Assessment of intraoperative quantitative shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions (FLLs) during liver surgery using postoperative histopathological results as the gold standard. Materials and Methods US data of 79 consecutive patients with 98 FLLs who underwent liver surgery between 08/2015 – 06/2017 were prospectively acquired and retrospectively analyzed. Multifrequency linear/T-shaped probes (6 – 9 MHz) were used to store cine loops of at least 5 s and images of B-mode, SWE and CEUS. The first CEUS loop was continuously documented over 1 min. in each case. Quantitative SWE analysis of FLLs was performed by placing 5 regions of interest to measure shear wave speed (m/s) and stiffness (kPa). CEUS was evaluated during the arterial, portal venous and late phase after i. v. bolus injections of 2.4 – 10 ml sulfur hexafluoride microbubbles. Postoperative histopathology after tumor resection or intraoperative biopsy was obtained to confirm findings of SWE and CEUS. Results Of 98 FLLs in 79 patients (mean age: 58 years sd ± 12y) 88 were malignant and 10 were benign ranging from 0.69 to 15.2 cm in size (mean: 2.8 cm, sd ± 2.25 cm). SWE characterized 73/88 FLLs correctly as malignant and 7/10 as benign using a cut-off value of 2.5 m/s/21.3 kPa (p < 0.0005). The sensitivity was 83 %, specificity 70 %, accuracy 82 %. CEUS could correctly identify 86/88 malignant and 8/10 benign FLLs. The sensitivity was 98 %, specificity 80 %, accuracy 96 %. SWE could correctly identify 2 malignant FLLs which CEUS falsely characterized as benign. Conclusion Intraoperative CEUS and SWE are excellent tools for the highly accurate visualization, characterization and malignancy assessment of hepatic tumors during liver surgery.

New Aspects Concerning Sulphur Hexafluoride Use As Contrast Agent for Ultrasonographyc Diagnosis

2017 ◽  
Vol 68 (2) ◽  
pp. 250-254
Author(s):  
Oana Timofte ◽  
Gabriela Stefanescu ◽  
Elena Gologan ◽  
Gheorghe G. Balan ◽  
Elena Toader ◽  
...  
Keyword(s):  
Contrast Agent ◽  
Focal Liver Lesions ◽  
European Federation ◽  
Liver Lesions ◽  
Sulphur Hexafluoride ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography ◽  
Examination Techniques ◽  
Malignant Lesions

Introduction of contrast agents as microbubbles and to improve ultrasound examination techniques has increased the rate of detection and characterization of liver lesions. Contrast-enhanced ultrasonography (CEUS) is a relatively new method of exploring the liver and diagnosing focal liver lesions (FLL). The aim of this study is to determine the efficiency of microbubbles used for CEUS in managing patients detected in conventional ultrasonography with FLL. We examined 84 patients with FLL, detected on conventional ultrasonography (US), during October 2012-September 2015. We performed contrast-enhanced ultrasonography, using sulphur hexafluoride as a contrast agent, and contrast-enhanced MRI to set the diagnosis. For 37 patients (44.1%) CEUS showed a malignity pattern of enhancement (according to the EFSUMB - European Federation of Societies for Ultrasound in Medicine and Biology- Guidelines 2012), while for 54 (64.3%) patients MRI set the diagnosis of malignity. CEUS detected fewer malignant lesions than MRI, in 20.1% of the cases MRI set de diagnosis. We need further studies in order to improve the quality of CEUS images and technique.

scholarly journals Quantitative Analysis of the Time–Intensity Curve of Contrast-Enhanced Ultrasound of the Liver: Differentiation of Benign and Malignant Liver Lesions

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1244
Author(s):  
Sonja Schwarz ◽  
Dirk-André Clevert ◽  
Michael Ingrisch ◽  
Thomas Geyer ◽  
Vincent Schwarze ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diagnostic Accuracy ◽  
Late Phase ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Malignant Lesions ◽  
Benign Liver ◽  
Benign Liver Lesions

Background: To evaluate the diagnostic accuracy of quantitative perfusion parameters in contrast-enhanced ultrasound to differentiate malignant from benign liver lesions. Methods: In this retrospective study 134 patients with a total of 139 focal liver lesions were included who underwent contrast enhanced ultrasound (CEUS) between 2008 and 2018. All examinations were performed by a single radiologist with more than 15 years of experience using a second-generation blood pool contrast agent. The standard of reference was histopathology (n = 60), MRI or CT (n = 75) or long-term CEUS follow up (n = 4). For post processing regions of interests were drawn both inside of target lesions and the liver background. Time–intensity curves were fitted to the CEUS DICOM dataset and the rise time (RT) of contrast enhancement until peak enhancement, and a late-phase ratio (LPR) of signal intensities within the lesion and the background tissue, were calculated and compared between malignant and benign liver lesion using Student’s t-test. Quantitative parameters were evaluated with respect to their diagnostic accuracy using receiver operator characteristic curves. Both features were then combined in a logistic regression model and the cumulated accuracy was assessed. Results: RT of benign lesions (14.8 ± 13.8 s, p = 0.005), and in a subgroup analysis, particular hemangiomas (23.4 ± 16.2 s, p < 0.001) differed significantly to malignant lesions (9.3 ± 3.8 s). The LPR was significantly different between benign (1.59 ± 1.59, p < 0.001) and malignant lesions (0.38 ± 0.23). Logistic regression analysis with RT and LPR combined showed a high diagnostic accuracy of quantitative CEUS parameters with areas under the curve of 0.923 (benign vs. malignant) and 0.929 (hemangioma vs. malignant. Conclusions: Quantified CEUS parameters are helpful to differentiate malignant from benign liver lesions, in particular in case of atypical hemangiomas.

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