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Evaluation of liver parenchyma stiffness in patients with liver tumours: optimal strategy for shear wave elastography

  • Ultrasound
  • Published:
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Abstract

Objectives

To determine the methodology of non-invasive test for evaluation of liver stiffness (LS) with tumours using two-dimensional (2D) shear wave elastography (SWE).

Methods

One hundred and twenty-seven patients with liver tumours underwent 2D-SWE before surgery to measure liver and spleen stiffness (SS). Two-dimensional SWE values were obtained in the liver at 0–1 cm, 1–2 cm and >2 cm from the tumour edge (PLS-1, PLS-2 and RLS, respectively). The influence of tumour-associated factors was evaluated. The area under the receiver operating characteristic curve (AUC) for each value was analysed to diagnose cirrhosis.

Results

PLS-1 was higher than PLS-2, which was even higher than RLS (p < 0.001). The AUCs of PLS-1, PLS-2, RLS and SS for diagnosing cirrhosis were 0.760, 0.833, 0.940 and 0.676, with the specificity of 75.7%, 67.6%, 90.3% and 77.4%, respectively. Tumour sizes, locations or types showed no apparent influence on 2D-SWE values except for RLS, which was higher in patients with primary hepatic carcinomas (p < 0.05).

Conclusions

LS with tumours is best measured at >2 cm away from the tumour edge. SS measurement could be used as an alternative to LS measurement in the event of no available liver for detection.

Key Points

• Tumour-associated factors impact background liver stiffness assessment.

• Background liver stiffness is best measured at >2 cm from tumour edge.

• Spleen stiffness can be an alternative to assess background liver stiffness.

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Abbreviations

2D-SWE:

Two-dimensional shear wave elastography

ALB:

Albumin

ALP:

Alkaline phosphatase

ALT:

Glutamate pyruvate transaminase

AST:

Glutamic oxaloacetic transaminase

CCC:

Cholangiocellular carcinoma

CV:

Coefficient of variation

DBIL:

Direct bilirubin

EFSUMB:

European Federation of Societies for Ultrasound in Medicine and Biology

GGT:

Glutamyl transpeptidase

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

LS:

Liver stiffness

MHC:

Metastatic hepatic carcinoma

PHLF:

Post-hepatectomy liver failure

PLS :

Peritumoural liver stiffness,

PLS-1 :

Peritumoural liver stiffness measured at 0–1 cm from the tumour edge

PLS-2:

Peritumoural liver stiffness measured at 1–2 cm from the tumour edge

PT:

Prothrombin time

RLS:

Remnant liver stiffness

SS:

Spleen stiffness

SSI:

Supersonic shear imaging

TBIL:

Total bilirubin

TE:

Transient elastography

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Wei Zheng and Zhong-guo Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China; Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong, 510060, People’s Republic of China

    Wei Zheng, Xiao-qing Pei, Qing Li & An-hua Li

  2. Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China; Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong, 510060, People’s Republic of China

    Zhong-guo Zhou, Chong-hei Wong & Min-Shan Chen

  3. Department of Oncology, Centro Hospitalar Conde de S. Januario (CHCSJ), Macao, People’s Republic of China

    Chong-hei Wong

  4. Department of Ultrasonography, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, 510120, People’s Republic of China

    Shu-lian Zhuang

  5. Minimally Invasive Interventional Centre, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China; Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong, 510060, People’s Republic of China

    Fu-jun Zhang

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  1. Wei Zheng
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Corresponding authors

Correspondence to Xiao-qing Pei or Fu-jun Zhang.

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Guarantor

The scientific guarantor of this publication is An-hua Li.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Zheng, W., Zhou, Zg., Wong, Ch. et al. Evaluation of liver parenchyma stiffness in patients with liver tumours: optimal strategy for shear wave elastography. Eur Radiol 29, 1479–1488 (2019). https://doi.org/10.1007/s00330-018-5676-8

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  • DOI: https://doi.org/10.1007/s00330-018-5676-8

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