Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultrasound



To determine the elasticity characteristics of focal liver lesions (FLLs) by shearwave elastography (SWE).


We used SWE in 108 patients with 161 FLLs and in the adjacent liver for quantitative and qualitative FLLs stiffness assessment. The Mann–Whitney test was used to assess the difference between the groups of lesions where a P value less than 0.05 was considered significant.


SWE acquisitions failed in 22 nodules (14 %) in 13 patients. For the 139 lesions successfully evaluated, SWE values were (in kPa), for the 3 focal fatty sparings (FFS) 6.6 ± 0.3, for the 10 adenomas 9.4 ± 4.3, for the 22 haemangiomas 13.8 ± −5.5, for the 16 focal nodular hyperplasias (FNHs) 33 ± −14.7, for the 2 scars 53.7 ± 4.7, for the 26 HCCs 14.86 ± 10, for the 53 metastasis 28.8 ± 16, and for the 7 cholangiocarcinomas 56.9 ± 25.6. FNHs had significant differences in stiffness compared with adenomas (P = 0.0002). Fifty percent of the FNHs had a radial pattern of elevated elasticity. A significant difference was also found between HCCs and cholangiocarcinomas elasticity (P = 0.0004).


SWE could be useful in differentiating FNHs and adenomas, or HCCs and cholangiocarcinomas by ultrasound.

Key Points

Elastography is becoming quite widely used as an adjunct to conventional ultrasound

Shearwave elastography (SWE) could help differentiate adenomas from fibrous nodular hyperplasia

SWE could also be helpful in distinguishing between hepatocellular carcinomas and cholangiocarcinomas

SWE could improve the identify hepatocellular carcinomas in cirrhotic livers

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Acoustic radiation force imaging




Contrast-enhanced ultrasound


Contrast-enhanced computed tomography


Focal liver lesion


Focal fatty sparing


Focal nodular hyperplasia


Hepatocellular carcinoma


Contrast-enhanced magnetic resonance imaging


Supersonic shear imaging


Shearwave elastography


Transient elastography


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We thank Matthew Brucce, Assistant Director of Ultrasound at Supersonic Imagine for remarks on shearwave elastography technology. The authors thank the Professor David Cosgrove for his help during the writing of this article.

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Correspondence to Aymeric Guibal.

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Guibal, A., Boularan, C., Bruce, M. et al. Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultrasound. Eur Radiol 23, 1138–1149 (2013). https://doi.org/10.1007/s00330-012-2692-y

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  • Elastography
  • Focal liver lesion
  • Shearwave elastography
  • Stiffness
  • Ultrasound