Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Liver Int. 2018 Jun;38(6):1055-1063. doi: 10.1111/liv.13611. Epub 2017 Nov 3.
BACKGROUND & AIMS: To analyse elastographic characteristics of focal liver lesions (FLL)s and diagnostic performance of real-time two-dimensional shear-wave elastography (RT-2D-SWE) in order to differentiate benign and malignant FLLs.
Consecutive patients diagnosed with FLL by abdominal ultrasound (US) underwent RT-2D-SWE of FLL and non-infiltrated liver by intercostal approach over the right liver lobe. The nature of FLL was determined by diagnostic work-up, including at least one contrast-enhanced imaging modality (MDCT/MRI), check-up of target organs when metastatic disease was suspected and FLL biopsy in inconclusive cases.
We analysed 196 patients (median age 60 [range 50-68], 50.5% males) with 259 FLLs (57 hepatocellular carcinomas, 17 cholangiocarcinomas, 94 metastases, 71 haemangiomas, 20 focal nodular hyperplasia) of which 70 (27%) were in cirrhotic liver. Malignant lesions were stiffer (P < .001) with higher variability in intralesional stiffness (P = .001). The best performing cut-off of lesion stiffness was 22.3 kPa (sensitivity 83%; specificity 86%; positive predictive value [PPV] 91.5%; negative predictive value [NPV] 73%) for malignancy. Lesion stiffness <14 kPa had NPV of 96%, while values >32.5 kPa had PPV of 96% for malignancy. Lesion stiffness, lesion/liver stiffness ratio and lesion stiffness variability significantly predicted malignancy in stepwise logistic regression (P < .05), and were used to construct a new Liver Elastography Malignancy Prediction (LEMP) score with accuracy of 96.1% in validation cohort (online calculator available at http://bit.do/lemps).
The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE.
分析肝脏局灶性病变（FLL）的弹性特征，评估实时二维剪切波弹性成像（RT-2D-SWE）对 FLL 良恶性的诊断效能。
连续入组经腹部超声（US）诊断为 FLL 的患者，采用肋间途径对 FLL 及无浸润肝组织进行 RT-2D-SWE。FLL 的性质通过诊断性检查确定，包括至少一种增强成像方式（MDCT/MRI），当怀疑转移疾病时对靶器官进行检查，在不确定的病例中进行 FLL 活检。
我们分析了 196 例患者（中位年龄 60 岁[范围 50-68 岁]，50.5%为男性）的 259 个 FLL（57 个肝细胞癌、17 个胆管细胞癌、94 个转移瘤、71 个肝血管瘤、20 个局灶性结节增生），其中 70 个（27%）位于肝硬化肝内。恶性病变的硬度更高（P<.001），病变内硬度的变异性更大（P=.001）。病变硬度的最佳截断值为 22.3kPa（敏感性 83%，特异性 86%，阳性预测值[PPV] 91.5%，阴性预测值[NPV] 73%）提示恶性。病变硬度<14kPa 对恶性病变的 NPV 为 96%，而病变硬度>32.5kPa 对恶性病变的 PPV 为 96%。在逐步逻辑回归中，病变硬度、病变/肝硬度比值和病变硬度变异性显著预测恶性病变（P<.05），并用于构建新的肝脏弹性成像恶性预测（LEMP）评分，在验证队列中的准确率为 96.1%（在线计算器可在 http://bit.do/lemps 获得）。
本研究中采用的综合方法可以使 96%的患者通过 RT-2D-SWE 正确区分 FLL 的良恶性。
