Bony George, Eldhose Elias George*, Vijay Narayanan H, Jijo Varghese, Antony George, Krishnadas Devadas
Background: Detection and characterization of focal liver lesions (FLLs) poses a frequent challenge in clinical practice. 2D-Shear Wave elastography (2D-SWE) is a recent technique which uses acoustic radiation force to induce mechanical vibrations and assess tissue elasticity
Aims: To study the elasticity characteristics of focal liver lesions by 2D shear wave elastography and to determine whether it can be used to differentiate benign from malignant lesions
Materials and methods: All patients with FLL underwent 2D-SWE and elasticity quantification. Contrast enhanced CT or MRI findings were used as the reference method for the diagnosis of FLLs Results: 216 patients with FLL were evaluated by the 2D-SWE. 130 patients had malignant FLLs of which 90 had Hepatocellular Carcinoma (HCC), 20 had Intrahepatic Cholangiocarcinoma (IHCC) and 20 had metastatic lesions. Of the 86 benign FLL, there were 36 Hemangiomas, 12 FNH, 24 simple cysts, 4 complex cysts, and 10 abscesses. Mean liver stiffness of various lesions by 2D-SWE was 65.7 (IHCC), 60.5 (HCC), 45.4 (Metastases), 7.6 (Hemangioma), 16.9 (FNH), 9.14 (abscess), 8.62 (simple cyst) and 2.95 (complex cyst). ROC analysis revealed that a SWE cut off of 40 kPa could distinguish between benign and malignant lesions with sensitivity of 100% and specificity of 80% (AUROC of 0.87). The lesion to background liver parenchyma stiffness ratio in cirrhotic patients was 4.81 for IHCC, 3.16 for metastasis and 1.93 For HCC. Therefore in cirrhotic patients, a lesion to liver stiffness ratio <2 along with SWE of lesion more than 40 kpa favors HCC. However in non-cirrhotic livers, there was no statistically significant difference between stiffness ratio of various malignant focal lesions.
Conclusion: 2D-SWE could be a useful non-invasive method for the differentiation of benign and malignant focal lesions of liver
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