nach oben

Erschienen in:

01.02.2015 | Gastrointestinal

Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography

verfasst von: Maxime Ronot, Sara Di Renzo, Bettina Gregoli, Rafael Duran, Laurent Castera, Bernard E. Van Beers, Valérie Vilgrain

Erschienen in: European Radiology | Ausgabe 2/2015

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To prospectively assess the stiffness of incidentally discovered focal liver lesions (FLL) with no history of chronic liver disease or extrahepatic cancer using shearwave elastography (SWE).

Methods

Between June 2011 and May 2012, all FLL fortuitously discovered on ultrasound examination were prospectively included. For each lesion, stiffness was measured (kPa). Characterization of the lesion relied on magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound, or biopsy. Tumour stiffness was analysed using ANOVA and non-parametric Mann-Whitney tests.

Results

105 lesions were successfully evaluated in 73 patients (61 women, 84 %) with a mean age of 44.8 (range: 20‒75). The mean stiffness was 33.3 ± 12.7 kPa for the 60 focal nodular hyperplasia (FNH), 19.7 ± 9.8 k Pa for the 17 hepatocellular adenomas (HCA), 17.1 ± 7 kPa for the 20 haemangiomas, 11.3 ± 4.3 kPa for the five focal fatty sparing, 34.1 ± 7.3 kPa for the two cholangiocarcinomas, and 19.6 kPa for one hepatocellular carcinoma (p < 0.0001). There was no difference between the benign and the malignant groups (p = 0.64). FNHs were significantly stiffer than HCAs (p < 0.0001). Telangiectatic/inflammatory HCAs were significantly stiffer than the steatotic HCAs (p = 0.014). The area under the ROC curve (AUROC) for differentiating FNH from other lesions was 0.86 ± 0.04.

Conclusion

SWE may provide additional information for the characterization of FFL, and may help in differentiating FNH from HCAs, and in subtyping HCAs.

Key Points

• SWE might be helpful for the characterization of solid focal liver lesions

• SWE cannot differentiate benign from malignant liver lesions

• FNHs are significantly stiffer than other benign lesions

• Telangiectatic/inflammatory HCA are significantly stiffer than steatotic ones

Reddy KR, Kligerman S, Levi J et al (2001) Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg 67:173–178PubMed

Vilgrain V (2006) Focal nodular hyperplasia. Eur J Radiol 58:236–245PubMedCrossRef

Dokmak S, Paradis V, Vilgrain V et al (2009) A Single-Center Surgical Experience of 122 Patients With Single and Multiple Hepatocellular Adenomas. Gastroenterology 137:1698–1705PubMedCrossRef

Harvey CJ, Albrecht T (2001) Ultrasound of focal liver lesions. Eur Radiol 11:1578–1593PubMedCrossRef

Noone TC, Semelka RC, Chaney DM, Reinhold C (2004) Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual. Magn Reson Imaging 22:19–24PubMedCrossRef

Holzapfel K, Bruegel M, Eiber M et al (2010) Characterization of small (</=10 mm) focal liver lesions: value of respiratory-triggered echo-planar diffusion-weighted MR imaging. Eur J Radiol 76:89–95PubMedCrossRef

Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J (2012) Detection, classification, and characterization of focal liver lesions: Value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. Abdom Imaging 37:74–82PubMedCrossRef

Agnello F, Ronot M, Valla DC, Sinkus R, Van Beers BE, Vilgrain V (2012) High-b-value diffusion-weighted MR imaging of benign hepatocellular lesions: quantitative and qualitative analysis. Radiology 262:511–519PubMedCrossRef

Tranquart F, Correas JM, Ladam Marcus V et al (2009) Real-time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study. J Radiol 90:109–122PubMedCrossRef

10.

Wang ZL, Tang J, Weskott HP et al (2008) Undetermined focal liver lesions on gray-scale ultrasound in patients with fatty liver: characterization with contrast-enhanced ultrasound. J Gastroenterol Hepatol 23:1511–1519PubMedCrossRef

11.

Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430PubMedCrossRef

12.

Quaia E, Stacul F, Gaiani S et al (2004) Comparison of diagnostic performance of unenhanced vs SonoVue - enhanced ultrasonography in focal liver lesions characterization. The experience of three Italian centers. Radiol Med 108:71–81PubMed

13.

Laumonier H, Bioulac-Sage P, Laurent C, Zucman-Rossi J, Balabaud C, Trillaud H (2008) Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 48:808–818PubMedCrossRef

14.

Ronot M, Bahrami S, Calderaro J et al (2011) Hepatocellular adenomas: accuracy of magnetic resonance imaging and liver biopsy in subtype classification. Hepatology 53:1182–1191PubMedCrossRef

15.

Semelka RC, Sofka CM (1997) Hepatic hemangiomas. Magn Reson Imaging Clin N Am 5:241–253PubMed

16.

Soussan M, Aubé C, Bahrami S, Boursier J, Valla DC, Vilgrain V (2010) Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. Eur Radiol 20:1715–1725PubMedCrossRef

17.

Hussain SM, Semelka RC (2005) Hepatic imaging: comparison of modalities. Radiol Clin North Am 43:929–947, ixPubMedCrossRef

18.

Semelka RC, Worawattanakul S, Kelekis NL et al (1997) Liver lesion detection, characterization, and effect on patient management: comparison of single-phase spiral CT and current MR techniques. J Magn Reson Imaging 7:1040–1047PubMedCrossRef

19.

Holalkere NS, Sahani DV, Blake MA, Halpern EF, Hahn PF, Mueller PR (2006) Characterization of small liver lesions: Added role of MR after MDCT. J Comput Assist Tomogr 30:591–596PubMedCrossRef

20.

Ladam-Marcus V, Mac G, Job L, Piot-Veron S, Marcus C, Hoeffel C (2009) Contrast-enhanced ultrasound and liver imaging: review of the literature. J Radiol 90:93–106, quiz 107-108PubMedCrossRef

21.

Friedrich-Rust M, Klopffleisch T, Nierhoff J et al (2013) Contrast-Enhanced Ultrasound for the differentiation of benign and malignant focal liver lesions: a meta-analysis. Liver Int. doi:10.1111/liv.12115 PubMed

22.

Grazioli L, Bondioni M, Haradome H (2012) Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid–enhanced MR Imaging in Differential Diagnosis. Radiol

23.

Ronot M, Paradis V, Duran R et al (2012) MR findings of steatotic focal nodular hyperplasia and comparison with other fatty tumours. Eur Radiol. doi:10.1007/s00330-012-2676-y PubMed

24.

Yoneda N, Matsui O, Kitao A et al (2012) Beta-catenin-activated hepatocellular adenoma showing hyperintensity on hepatobiliary-phase gadoxetic-enhanced magnetic resonance imaging and overexpression of OATP8. Jpn J Radiol 30:777–782PubMedCrossRef

25.

Thomeer MG, Willemssen FE, Biermann KK et al (2013) MRI features of inflammatory hepatocellular adenomas on hepatocyte phase imaging with liver-specific contrast agents. J Magn Reson Imaging. doi:10.1002/jmri.24281 PubMed

26.

Purysko AS, Remer EM, Coppa CP, Obuchowski NA, Schneider E, Veniero JC (2012) Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. Am J Roentgenol 198:115–123CrossRef

27.

Grieser C, Steffen IG, Kramme IB et al (2014) Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience. Eur Radiol. doi:10.1007/s00330-014-3144-7

28.

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

29.

Van Beers BE, Doblas S, Sinkus R (2012) New acquisition techniques: fields of application. Abdom Imaging 37:155–163PubMedCrossRef

30.

Sandrin L, Fourquet B, Hasquenoph JM et al (2003) Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 29:1705–1713PubMedCrossRef

31.

Castera L, Vergniol J, Foucher J et al (2005) Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 128:343–350PubMedCrossRef

32.

Ziol M, Handra-Luca A, Kettaneh A et al (2005) Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 41:48–54PubMedCrossRef

33.

Castera L (2012) Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology 142(1293–1302):e1294

34.

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

35.

Fahey BJ, Nightingale KR, Nelson RC, Palmeri ML, Trahey GE (2005) Acoustic radiation force impulse imaging of the abdomen: demonstration of feasibility and utility. Ultrasound Med Biol 31:1185–1198PubMedCrossRef

36.

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

37.

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

38.

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

39.

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

40.

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

41.

Zhang P, Zhou P, Tian SM, Qian Y, Deng J, Zhang L (2013) Application of acoustic radiation force impulse imaging for the evaluation of focal liver lesion elasticity. Hepatobiliary Pancreat Dis Int 12:165–170PubMedCrossRef

42.

Park H, Park JY, Do Kim Y et al (2013) Characterization of focal liver masses using acoustic radiation force impulse elastography. World J Gastroenterol 19:219–226PubMedCentralPubMedCrossRef

43.

Frulio N, Laumonier H, Carteret T et al (2013) Evaluation of liver tumors using acoustic radiation force impulse elastography and correlation with histologic data. J Ultrasound Med 32:121–130PubMedCrossRef

44.

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

45.

Cosgrove D, Piscaglia F, Bamber J et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 34:238–253PubMedCrossRef

46.

Ishak K, Baptista A, Bianchi L et al (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22:696–699PubMedCrossRef

47.

Guibal A, Boularan C, Bruce M et al (2012) Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultrasound. Eur Radiol. doi:10.1007/s00330-012-2692-y

48.

Hata S, Imamura H, Aoki T et al (2011) Value of visual inspection, bimanual palpation, and intraoperative ultrasonography during hepatic resection for liver metastases of colorectal carcinoma. World J Surg 35:2779–2787PubMedCrossRef

49.

Ying L, Hou Y, Zheng HM, Lin X, Xie ZL, Hu YP (2012) Real-time elastography for the differentiation of benign and malignant superficial lymph nodes: a meta-analysis. Eur J Radiol 81:2576–2584PubMedCrossRef

50.

Bioulac-Sage P, Balabaud C, Bedossa P et al (2007) Pathological diagnosis of liver cell adenoma and focal nodular hyperplasia: Bordeaux update. J Hepatol 46:521–527PubMedCrossRef

51.

Bioulac-Sage P, Laumonier H, Couchy G, et al. (2009) Hepatocellular Adenoma Management and Phenotypic Classification: the Bordeaux Experience. Hepatol: 1-9

52.

Mannelli L, Wilson GJ, Dubinsky TJ et al (2012) Assessment of the liver strain among cirrhotic and normal livers using tagged MRI. J Magn Reson Imaging 36:1490–1495PubMedCrossRef

53.

Venkatesh SK, Yin M, Ehman RL (2013) Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Reson Imaging 37:544–555PubMedCentralPubMedCrossRef

54.

Huwart L, Salameh N, ter Beek L et al (2008) MR elastography of liver fibrosis: preliminary results comparing spin-echo and echo-planar imaging. Eur Radiol 18:2535–2541PubMedCrossRef

Titel: Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography
verfasst von: Maxime Ronot
Sara Di Renzo
Bettina Gregoli
Rafael Duran
Laurent Castera
Bernard E. Van Beers
Valérie Vilgrain
Publikationsdatum: 01.02.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3370-z

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography