The Value Of Multimodal Ultrasonography In Differentiating Focal Liver Lesions

Objectives:The purpose of this study is to evaluate the value of shear wave elastography(SWE),contrast-enhanced ultrasound(CEUS)and SWE combined with CEUS for diagnosis of focal liver lesions(FLLs).Methods:Between September 2018 and September 2019,a total of 85 patients with 150 FLLs were recruited.All patients included received grey-scale ultrasound,CEUS and SWE.The diagnosis of all lesions was based on the clinical diagnosis standard,and the FLLs with no conclusion of the clinical diagnosis standard was determined by histological examination results.Characteristics of E-max,E-mean,E-min in different FLLs and Cutoff value were analyzed from the SWE results.Taking the final diagnosis results(clinical diagnosis standard or histological examination results)as golden standard,ROC curve of traditional Ultrasound,CEUS,SWE and SWE+CEUS were analyzed to compare diagnostic efficacy among those methods.Results:Among the 129 focal liver lesions in 75 patients who successfully achieved two-dimensional ultrasound,contrast-enhanced ultrasound and shear wave elastography,there were 51 benign lesions(including 40 hemangiomas,5 focal fatty livers,5 focal nodular hyperplasia(FNH),1 parasitic infection)and 78 malignant lesions(including 21 primary hepatocellular carcinoma(HCC),9 primary cholangiocellular carcinoma(CCC)and 48 liver metastases).Different FLLs have different range of Young's modulus.The mean values of E-max,E-mean and E-min in malignant lesions were higher than those in benign lesions with statistically significant difference(P < 0.05).The sequence of AUC among E-max,E-mean,E-min and CEUS in diagnosing FLLs was as follows: E-max >Emean > CEUS >E-min,but there was no significant difference among them(P > 0.05).The AUCs of those techniques were significantly higher than that of traditional Ultrasound.The AUC of SWE+CEUS was the highest,which was 0.942.And the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of it were 96.2%?98.0%?98.7%?94.3%?96.9%,respectively.Significantly greater than the diagnosis efficacy of E-max,E-mean E-min and CEUS.Conclusions: Contrast-enhanced ultrasound and shear wave elastography can be used to evaluate the nature of focal liver lesions.Different FLLs have different range of Young's modulus value.Young's modulus value can not be used to judge the benign and malignant nature of FLLs alone for Young's modulus values in some types of benign and malignant FLLs have cross(such as FNH).So,the diagnosis of FLLs should be based on CEUS diagnosis results first.There was no significant difference in AUC among E-max,E-mean,E-min and CEUS for the diagnosis of FLLs.SWE+ CEUS combined diagnosis can greatly improve the accuracy of FLLS diagnosis.