European Radiology

, Volume 25, Issue 2, pp 346–358 | Cite as

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

  • Maxime RonotEmail author
  • Sara Di Renzo
  • Bettina Gregoli
  • Rafael Duran
  • Laurent Castera
  • Bernard E. Van Beers
  • Valérie Vilgrain



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).


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.


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.


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


Elastography Shearwave Focal liver lesion Fortuitous Benign 



acoustic radiation force impulse imaging


contrast-enhanced ultrasound


computed tomography


focal fatty sparing


focal liver lesion


focal nodular hyperplasia

tHCA or sHCA

telangiectatic/inflammatory or steatotic hepatocellular adenoma


hepatocellular carcinoma


intrahepatic cholangiocarcinoma


magnetic resonance imaging


region of interest


shearwave elastography





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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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Maxime Ronot
    • 1
    • 2
    • 3
    • 6
    Email author
  • Sara Di Renzo
    • 1
  • Bettina Gregoli
    • 1
  • Rafael Duran
    • 1
    • 4
  • Laurent Castera
    • 2
    • 5
  • Bernard E. Van Beers
    • 1
    • 2
    • 3
  • Valérie Vilgrain
    • 1
    • 2
    • 3
  1. 1.Department of Radiology, APHPUniversity Hospitals Paris Nord Val de SeineClichyFrance
  2. 2.University Paris DiderotParisFrance
  3. 3.INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3ParisFrance
  4. 4.Department of RadiologyCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland
  5. 5.Department of Hepatology, APHPUniversity Hospitals Paris Nord Val de SeineClichyFrance
  6. 6.Department of RadiologyBeaujon Hospital, AP-HPClichyFrance

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