Evaluation of 2D- Shear Wave Elastography for Characterisation of Focal Liver Lesions

2017 ◽  
Vol 26 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Ludmila Gerber ◽  
Daniel Fitting ◽  
Kajana Srikantharajah ◽  
Nina Weiler ◽  
Georgia Kyriakidou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Shear Wave ◽  
Focal Nodular Hyperplasia ◽  
Shear Wave Elastography ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Nodular Hyperplasia ◽  
Glutamyl Transferase

Background & Aim: This is a prospective study for evaluation of 2D-shear wave elastography (2D-SWE) for characterisation and differentiation of benign und malignant focal liver lesions (FLLs).Methods: The patients referred to our ultrasound unit were prospectively included. B-mode ultrasound and 2D-SWE (Aixplorer® France) were performed for one FLL in each patient. Liver histology and/or contrast-enhanced imaging were used as a reference method.Results: 140 patients with FLL were included. SWE acquisitions failed in 24% of them. Therefore, 106 patients with FLL could be analysed, 42/106 with benign and 64/106 with malignant FLLs. The median stiffness for benign FLLs was 16.4 (2.1-71.9) kPa: 16.55 kPa for 18 focal nodular hyperplasia (FNH), 16.35 kPa for 18 hemangioma, 9.8 kPa for 3 focal fatty sparings (FFS), 8.9 kPa for 1 adenoma, 20 kPa for one regenerative node and 29 kPa for one cholangiofibroma, and for the malignant FLLs 36 (4.1-142.9) kPa: 44.8 kPa for 16 hepatocellular carcinoma (HCC), 70.7 kPa for 7 cholangiocarcinoma (CCC) and 29.5 kPa for the 41 metastasis (p<0.001). Malignant FLLs were significantly stiffer than benign FLLs (p<0.0001). Cholangiocarcinomas were the stiffest malignant FFLs with significantly higher values as compared to HCCs and metastases (p=0.033 and p=0.0079, respectively). No significant difference in stiffness could be observed between the different benign FLL entities. No significant difference was observed whether 2D-SWE included the whole FLL, the periphery or only the hardest area of the FLL.Conclusions: 2D-SWE provides further characterising information for interpretation of FLLs and may be useful at least in differentiation of CCCs and HCCs.Abbreviations: ALT: alanine aminotransaminase; AST: aspartate aminotransaminase; AUROC: area under the ROC; ARFI: acoustic radiation force impulse; CCC: cholangiocarcinoma; CECT: contrast-enhanced CT; CEMRI: contrast-enhanced MRI; CEUS: contrast-enhanced ultrasound; FFS: focal fatty sparing; FLL: focal liver lesion; FNH: focal nodular hyperplasia; GGT: gamma-glutamyl-transferase; HCC: hepatocellular carcinoma; NASH: nonalcoholic steatohepatitis; pSWE: point shear wave elastography; ROC: receiver-operating-characteristic; ROI: region of interest; 2D-SWE: 2D-shear wave elastography; TE: transient elastography.

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.

scholarly journals Correlation of the Stiffness of Hepatocellular Carcinoma and Surrounding Liver Parenchyma by Point Shear Wave Elastography

2018 ◽  
Vol 35 (1) ◽  
pp. 10-15
Author(s):  
Bundit Chaopathomkul ◽  
Ornalin Boonsirisak ◽  
Krit Pongpirul
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Fibrosis ◽  
Shear Wave ◽  
Statistical Significance ◽  
Shear Wave Elastography ◽  
Liver Parenchyma ◽  
Significant Fibrosis ◽  
Significant Difference ◽  
Comparison Groups ◽  
Cirrhotic Group

The purpose of this study was to assess the correlation between hepatocellular carcinoma (HCC) and surrounding liver parenchyma stiffness using point shear wave elastography (pSWE). HCC was diagnosed using the criteria of the American Association for the Study of Liver Diseases. Liver fibrosis was classified into three groups (nonsignificant fibrosis, significant fibrosis, and cirrhosis). pSWE was performed on the HCC and the adjacent hepatic parenchyma and was expressed as kilopascal (kPa). A total of 59 HCC patients with 64 tumors were included in the study. The mean stiffnesses of HCC and liver background were 9.25 ± 3.76 and 10.84 ± 4.81 kPa, respectively. There was no statistical significance in HCC stiffness in any stage of liver fibrosis. Low HCC/liver background stiffness ratio was noted in the cirrhotic group and statistically significant in two comparison groups (cirrhosis vs significant fibrosis and cirrhosis vs nonsignificant fibrosis), with P < .001. In this cohort, HCC stiffness alone demonstrated no statistically significant difference in various stages of liver fibrosis.

scholarly journals Is There a Place for Elastography in the Diagnosis of Hepatocellular Carcinoma?

2021 ◽  
Vol 10 (8) ◽  
pp. 1710
Author(s):  
Ana-Maria Ghiuchici ◽  
Ioan Sporea ◽  
Mirela Dănilă ◽  
Roxana Șirli ◽  
Tudor Moga ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Shear Wave Elastography ◽  
Abdominal Ultrasound ◽  
Liver Parenchyma ◽  
Final Diagnosis ◽  
Focal Liver Lesions ◽  
Additional Information ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced

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.

An MR-Based Radiomics Model for Differentiation Between Hepatocellular Carcinoma and Focal Nodular Hyperplasia in Non-Cirrhotic Liver

2021 ◽  
Author(s):  
Zongren Ding ◽  
Kongying Lin ◽  
Jun Fu ◽  
Qizhen Huang ◽  
Guoxu Fang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Focal Nodular Hyperplasia ◽  
Cirrhotic Liver ◽  
Arterial Phase ◽  
Training Set ◽  
Combined Model ◽  
Clinical Model ◽  
Contrast Enhanced ◽  
Nodular Hyperplasia ◽  
Validation Set

Abstract Purpose:This study aimed to develop and validate a radiomics model for differentiating between hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) in non-cirrhotic livers using Gd-DTPA contrast-enhanced magnetic resonance imaging (MRI).Methods:We retrospectively enrolled 149 HCC patients and 75 FNH patients seen between May 2015 and May 2019 at our center and randomly allocated patients to a training set (n = 156) and a validation set (n = 68). A total of 2,260 radiomics features were extracted from the arterial phase and portal venous phase of Gd-DTPA contrast-enhanced MRI. Using Max-Relevance and Min-Redundancy, random forests, and the least absolute shrinkage and selection operator algorithm for dimensionality reduction, multivariable logistic regression was used to build the radiomics model. A clinical model and combined model were also established. The diagnostic performance of the three models was compared. Results:Eight radiomics features were chosen to build a radiomics model, and four clinical factors (age, sex, HbsAg, and enhancement pattern) were chosen to build the clinical model. When evaluating the performance of three models, the clinical model that included clinical data and visual MRI findings achieved excellent performance in the training set (AUC, 0.937; 95% CI, 0.887–0.970) and the validation set (AUC, 0.903; 95% CI, 0.807–0.962), and there was no significant difference between the radiomics model and the clinical model. The AUC of the combined model was significantly better than that of the clinical model for both the training (0.984 vs. 0.937, p = 0.002) and validation (0.972 vs. 0.903, p = 0.032) sets.Conclusions:The combined model based on clinical and radiomics features can well distinguish HCC from FNH in non-cirrhotic liver. Our model may assist clinicians in the clinical decision-making process.

Sign in / Sign up

Export Citation Format

Share Document