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

  • Gastrointestinal
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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

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Abbreviations

ARFI:

acoustic radiation force impulse imaging

CEUS:

contrast-enhanced ultrasound

CT:

computed tomography

FFS:

focal fatty sparing

FLL:

focal liver lesion

FNH:

focal nodular hyperplasia

tHCA or sHCA:

telangiectatic/inflammatory or steatotic hepatocellular adenoma

HCC:

hepatocellular carcinoma

ICC:

intrahepatic cholangiocarcinoma

MRI:

magnetic resonance imaging

ROI:

region of interest

SWE:

shearwave elastography

US:

ultrasound

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Acknowledgments

The scientific guarantor of this publication is Valérie Vilgrain. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic, or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France

    Maxime Ronot, Sara Di Renzo, Bettina Gregoli, Rafael Duran, Bernard E. Van Beers & Valérie Vilgrain

  2. University Paris Diderot, Sorbonne Paris Cité, Paris, France

    Maxime Ronot, Laurent Castera, Bernard E. Van Beers & Valérie Vilgrain

  3. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France

    Maxime Ronot, Bernard E. Van Beers & Valérie Vilgrain

  4. Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    Rafael Duran

  5. Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France

    Laurent Castera

  6. Department of Radiology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118, Clichy, France

    Maxime Ronot

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  1. Maxime Ronot
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  2. Sara Di Renzo
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Correspondence to Maxime Ronot.

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Ronot, M., Di Renzo, S., Gregoli, B. et al. Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography. Eur Radiol 25, 346–358 (2015). https://doi.org/10.1007/s00330-014-3370-z

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  • DOI: https://doi.org/10.1007/s00330-014-3370-z

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