Role of Ultrasound Elastography in Characterizing Focal Liver Lesions with Pathological Correlation

Abstract

INTRODUCTION:  Focal liver lesions (FLL) has been increasingly detected due to widespread imaging techniques and thus necessitates a thorough evaluation involving radiology, pathology, physical examination, and patient history. Ultrasonic elastography measures tissue elasticity helps differentiate between malignant and benign lesions. The primary objective is to evaluate the sensitivity and specificity of elastographic parameters in distinguishing malignant from benign liver tumors. Additionally to assess ultrasound elastographic parameters (stiffness value, stiffness ratio, and shear wave velocity) and to compare these parameters across different types of lesions, correlating them with pathological results.

MATERIALS AND METHODS: In a study of 60 patients with focal liver lesions, both grey scale and elastographic evaluations were conducted over 18 months at Sri Manakula Vinayagar Medical College. Diagnoses were confirmed via FNAC, biopsy, or cross-sectional imaging. The Receiver Operating Characteristic (ROC) curve was used to determine malignancy cutoff, with a p-value <0.05 considered significant. Data were analyzed using SPSS version 16.

RESULTS: Of 60 participants, 18 had benign lesions and 42 had malignancies. The mean stiffness (kPa) was 2.81 ± 1.24 for benign lesions and 6.47 ± 2.49 for malignant ones. The stiffness ratio averaged 4.08 ± 1.13 for benign and 8.63 ± 4.09 for malignant lesions. The mean shear wave velocity (SWV) was 0.90 ± 0.28 m/s for benign and 1.55 ± 0.63 m/s for malignant lesions. We identified a stiffness cutoff of 4.6 kPa, with 85.7% sensitivity and 94.4% specificity, and a stiffness ratio cutoff of 4.8, with 83.3% sensitivity and 77.7% specificity (P ≤ 0.01). The SWV cutoff was 1.1 m/s, with 78.6% sensitivity and 83.3% specificity in distinguishing malignant from benign liver lesions.

CONCLUSION: This study helps to assess the utility of ultrasonic elastography in characterizing FLLs and supporting care decisions. Our study identified stiffness value as the most effective parameter.