Role of 2D shear wave elastography in differentiating malignancy from focal liver lesions as compared to multiphasic contrast enhanced computed tomography

Abstract

Background: Liver cancer is the third most common cause of cancer mortality worldwide. A precise evaluation of benign and malignant liver lesions is very important for the patients.  In the present study, we aim to evaluate the use of SWE in the differentiation of malignant from benign focal liver lesions and to determine the SWE characteristics of common liver lesions as compared to multiphasic computed tomography (CT) scan. Methods: Diagnostic test evaluation observational study where sensitivity, specificity, PPV and NPV of both modalities 2D SWS and multiphase contrast-enhanced-computed tomography (CECT) are compared. 63 patients with focal liver lesions were evaluated by both modalities with HPE as gold standard. Results: Overall sensitivity, specificity, PPV, NPV and accuracy of multiphasic CECT is 89.74%, 50.00%, 10.28%, 99.39% and 98.71% respectively. Overall sensitivity, specificity, PPV, NPV and accuracy of 2D SWS is 94.59%, 56.25%, 12.13%, 99.39% and 58.55% respectively. Conclusions: 2D SWS is a useful modality and is capable of evaluating stiffness changes in the liver associated with solid focal liver lesions, which helps in distinguishing benign from malignant lesions and also in their sub-categorization, i.e., differentiating focal nodular hyperplasia from hemangioma and differentiating hepatocellular carcinoma, with high sensitivity and accuracy.  Overall performance of both CECT and 2D SWS did not show much difference statistically. However, both modalities complement each other and shortcoming of one modality can be overcome with the help of other thereby leading to better diagnostic evaluation.