Top

Published in:

01-04-2013 | Ultrasound

Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultrasound

Authors: Aymeric Guibal, Camille Boularan, Matthew Bruce, Mélanie Vallin, Frank Pilleul, Thomas Walter, Jean Yves Scoazec, Nawele Boublay, Jérôme Dumortier, Thibaut Lefort

Published in: European Radiology | Issue 4/2013

Abstract

Objectives

To determine the elasticity characteristics of focal liver lesions (FLLs) by shearwave elastography (SWE).

Methods

We used SWE in 108 patients with 161 FLLs and in the adjacent liver for quantitative and qualitative FLLs stiffness assessment. The Mann–Whitney test was used to assess the difference between the groups of lesions where a P value less than 0.05 was considered significant.

Results

SWE acquisitions failed in 22 nodules (14 %) in 13 patients. For the 139 lesions successfully evaluated, SWE values were (in kPa), for the 3 focal fatty sparings (FFS) 6.6 ± 0.3, for the 10 adenomas 9.4 ± 4.3, for the 22 haemangiomas 13.8 ± −5.5, for the 16 focal nodular hyperplasias (FNHs) 33 ± −14.7, for the 2 scars 53.7 ± 4.7, for the 26 HCCs 14.86 ± 10, for the 53 metastasis 28.8 ± 16, and for the 7 cholangiocarcinomas 56.9 ± 25.6. FNHs had significant differences in stiffness compared with adenomas (P = 0.0002). Fifty percent of the FNHs had a radial pattern of elevated elasticity. A significant difference was also found between HCCs and cholangiocarcinomas elasticity (P = 0.0004).

Conclusions

SWE could be useful in differentiating FNHs and adenomas, or HCCs and cholangiocarcinomas by ultrasound.

Key Points

• Elastography is becoming quite widely used as an adjunct to conventional ultrasound

• Shearwave elastography (SWE) could help differentiate adenomas from fibrous nodular hyperplasia

• SWE could also be helpful in distinguishing between hepatocellular carcinomas and cholangiocarcinomas

• SWE could improve the identify hepatocellular carcinomas in cirrhotic livers

Wernecke K, Rummeny E, Bongartz G et al (1991) Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging. AJR Am J Roentgenol 157:731–739PubMedCrossRef

Celli N, Gaiani S, Piscaglia F et al (2007) Characterization of liver lesions by real-time contrast-enhanced ultrasonography. Eur J Gastroenterol Hepatol 19:3–14PubMedCrossRef

Lindor KD, Bru C, Jorgensen RA et al (1996) The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology 23:1079–1083PubMedCrossRef

Atwell TD, Smith RL, Hesley GK et al (2010) Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. AJR Am J Roentgenol 194:784–789PubMedCrossRef

Yeh WC, Li PC, Jeng YM et al (2002) Elastic modulus measurements of human liver and correlation with pathology. Ultrasound Med Biol 28:467–474PubMedCrossRef

Russo A, Sparacino G, Plaja S et al (1989) Role of intraoperative ultrasound in the screening of liver metastases from colorectal carcinoma: initial experiences. J Surg Oncol 42:249–255PubMedCrossRef

Lyshchik A, Higashi T, Asato R et al (2005) Thyroid gland tumor diagnosis at US elastography. Radiology 237:202–211PubMedCrossRef

Tsutsumi M, Miyagawa T, Matsumura T et al (2007) The impact of real-time tissue elasticity imaging (elastography) on the detection of prostate cancer: clinicopathological analysis. Int J Clin Oncol 12:250–255PubMedCrossRef

Thomas A, Fischer T, Frey H et al (2006) Real-time elastography—an advanced method of ultrasound: first results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 28:335–340PubMedCrossRef

10.

Saftoiu A, Vilman P (2006) Endoscopic ultrasound elastography—a new imaging technique for the visualization of tissue elasticity distribution. J Gastrointestin Liver Dis 15:161–165PubMed

11.

Kato K, Sugimoto H, Kanazumi N, Nomoto S, Takeda S, Nakao A (2008) Intra-operative application of real-time tissue elastography for the diagnosis of liver tumours. Liver Int 28:1264–1271PubMedCrossRef

12.

Foucher J, Chanteloup E, Vergniol J et al (2006) Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 55:403–408PubMedCrossRef

13.

Masuzaki R, Tateishi R, Yoshida H et al (2007) Assessing liver tumor stiffness by transient elastography. Hepatol Int 1:394–397PubMedCrossRef

14.

Heide R, Strobel D, Bernatik T, Goertz RS (2010) Characterization of focal liver lesions (FLL) with acoustic radiation force impulse (ARFI) elastometry. Ultraschall Med 31:405–409PubMedCrossRef

15.

Yu H, Wilson SR (2011) Differentiation of benign from malignant liver masses with Acoustic Radiation Force Impulse technique. Ultrasound Q 27:217–223PubMedCrossRef

16.

Gallotti A, D’Onofrio M, Romanini L, Cantisani V, Pozzi Mucelli R (2012) Acoustic Radiation Force Impulse (ARFI) ultrasound imaging of solid focal liver lesions. Eur J Radiol 81:451–455PubMedCrossRef

17.

Cho SH, Lee JY, Han JK, Choi BI (2010) Acoustic radiation force impulse elastography for the evaluation of focal solid hepatic lesions: preliminary findings. Ultrasound Med Biol 36:202–208PubMedCrossRef

18.

Davies G, Koenen M (2011) Acoustic radiation force impulse elastography in distinguishing hepatic haemangiomata from metastases: preliminary observations. Br J Radiol 84:939–943PubMedCrossRef

19.

Fahey BJ, Nelson RC, Bradway DP, Hsu SJ, Dumont DM, Trahey GE (2008) In vivo visualization of abdominal malignancies with acoustic radiation force elastography. Phys Med Biol 53:279–293PubMedCrossRef

20.

Ying L, Lin X, Xie ZL, Tang FY, Hu YP, Shi KQ (2012) Clinical utility of acoustic radiation force impulse imaging for identification of malignant liver lesions: a meta-analysis. Eur Radiol. doi: 10.1007/s00330-012-2540-0

21.

Cosgrove DO, Berg WA, Dore CJ et al (2012) Shear wave elastography for breast masses is highly reproducible. Eur Radiol 22:1023–1032PubMedCrossRef

22.

Berg WA, Cosgrove DO, Dore CJ et al (2012) Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology 262:435–449PubMedCrossRef

23.

Ferraioli G, Tinelli C, Zicchetti M et al (2012) Reproducibility of real-time shear wave elastography in the evaluation of liver elasticity. Eur J Radiol 81:3102–3106

24.

Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236PubMedCrossRef

25.

Bartolozzi C, Battaglia V, Bozzi E (2011) Hepatocellular nodules in liver cirrhosis: contrast-enhanced MR. Abdom Imaging 36:290–299PubMedCrossRef

26.

Garteiser P, Doblas S, Daire JL et al (2012) MR elastography of liver tumours: value of viscoelastic properties for tumour characterisation. Eur Radiol 22:2169–2177PubMedCrossRef

27.

Bercoff J, Tanter M, Fink M (2004) Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control 51:396–409PubMedCrossRef

28.

Buetow PC, Pantongrag-Brown L, Buck JL, Ros PR, Goodman ZD (1996) Focal nodular hyperplasia of the liver: radiologic-pathologic correlation. Radiographics 16:369–388PubMed

29.

Hoyt K, Warram JM (2009) Quantitative elasticity measurements reveal intratumoral changes in response to antiangiogenic therapy—preliminary results. Proceedings of the 2009 IEEE Ultrasonics Symposium, Rome, pp 1443–1446

30.

Sirica AE, Campbell DJ, Dumur CI (2011) Cancer-associated fibroblasts in intrahepatic cholangiocarcinoma. Curr Opin Gastroenterol 27:276–284PubMedCrossRef

31.

Okamoto K, Tajima H, Ohta T et al (2010) Angiotensin II induces tumor progression and fibrosis in intrahepatic cholangiocarcinoma through an interaction with hepatic stellate cells. Int J Oncol 37:1251–1259PubMedCrossRef

32.

Vilana R, Forner A, Bianchi L et al (2009) Intrahepatic peripheral cholangiocarcinoma in cirrhosis patients may display a vascular pattern similar to hepatocellular carcinoma on contrast-enhanced ultrasound. Hepatology 51:2020–2029CrossRef

33.

Ariizumi S, Kotera Y, Takahashi Y et al (2011) Mass-forming intrahepatic cholangiocarcinoma with marked enhancement on arterial-phase computed tomography reflects favorable surgical outcomes. J Surg Oncol 104:130–139PubMedCrossRef

34.

Padera TP, Stoll BR, Tooredman JB, Capen D, di Tomaso E, Jain RK (2004) Pathology: cancer cells compress intratumour vessels. Nature 427:695PubMedCrossRef

35.

Paszek MJ, Weaver VM (2004) The tension mounts: mechanics meets morphogenesis and malignancy. J Mammary Gland Biol Neoplasia 9:325–342PubMedCrossRef

36.

Wu J, Long Q, Xu S, Padhani AR (2009) Study of tumor blood perfusion and its variation due to vascular normalization by anti-angiogenic therapy based on 3D angiogenic microvasculature. J Biomech 42:712–721PubMedCrossRef

Title: Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultrasound
Authors: Aymeric Guibal
Camille Boularan
Matthew Bruce
Mélanie Vallin
Frank Pilleul
Thomas Walter
Jean Yves Scoazec
Nawele Boublay
Jérôme Dumortier
Thibaut Lefort
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2692-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultrasound

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 4/2013

C-arm CT during hepatic arteriography tumour-to-liver contrast: intraindividual comparison of three different contrast media application protocols

Impact of breast mass size on accuracy of ultrasound elastography vs. conventional B-mode ultrasound: a meta-analysis of individual participants

Albumin-binding MR blood pool contrast agent improves diagnostic performance in human brain tumour: comparison of two contrast agents for glioblastoma

Peritoneal inclusion cysts: clinical characteristics and imaging features

Reliability and responsiveness of the Juvenile Arthritis MRI Scoring (JAMRIS) system for the knee

Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma