Application Value Of Multimodal Ultrasound In Hepatic Space Occupying Lesions

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Diagnostic value of shear wave elastography in hepatic space occupying lesions Objective:To analyze the characteristics of Shear Wave Elastography(SWE)of hepatic space occupying lesions,to study the correlation between the diameter of the lesions and Young's modulus,to assess the best diagnostic cutoff for SWE in the differential diagnosis of hepatic space occupying lesions,and to explore the diagnostic value and clinical application value of SWE in hepatic space occupying lesions.Methods:153 lesions of 131 patients who underwent SWE examination in our hospital from December 2017 to December 2019 were included in the study,and the results of pathological diagnosis or imaging diagnosis were used as controls.There were 89 malignant lesions,46 hepatocellular carcinomas(HCC),12 intrahepatic cholangiocellular carcinomas(ICC),and 31 metastatic liver cancers(MLC);there were 64 benign lesions,55 hepatic hemangiomas,1 focal nodular hyperplasia(FNH),and 8 regenerative nodules(RN).Measure the maximum diameter of these lesions,and explore the correlation between the maximum diameter of the lesions and the Young's modulus value.Measure the average Young's modulus(Emean),maximum Young's modulus(Emax),and ratio to Young's modulus(Eratio),compare the difference in Young's modulus between benign and malignant,and compare the difference of Young's modulus between HCC,ICC and MLC.Receiver Operating Characteristic Curve(ROC)was drawn to obtain the benign and malignant diagnostic cutoffs for hepatic space occupying lesions.Results:The diameter of the lesions was about 1.75-11.33cm(4.25±1.84cm),the average diameter of the malignant lesions was 4.63±2.01 cm,the average diameter of the benign lesions was 3.73±1.52 cm,the average diameter of the hemangioma was 3.89±1.46 cm,the average diameter of RN was2.23±0.49 cm.There is a weak positive correlation between Emean and Emax of malignant lesions and their diameters,r=0.22(P<0.05)and r=0.32(P<0.05);there is a strong positive correlation between Emean and diameter of hepatic hemangioma,r=0.75(P<0.05),there is a moderately positive correlation between Emax and diameter,r=0.52(P<0.05);the correlation coefficient between RN's Emean and its diameter was 0.121(P> 0.05),and the correlation coefficient between Emax and its diameter was 0.173(P> 0.05).The correlation between RN's Emean and Emax and their diameter was not significant.The Emean,Emax,and Eratio values of malignant lesions were 39.24±16.65 kPa,66.90±34.23 kPa,and 4.67±2.06 kPa respectively;the Emean,Emax,and Eratio values of benign lesions were 23.71±6.57 kPa,33.70±7.52 kPa,3.45±1.13,the Emean,Emax,and Eratio of malignant lesions were larger than those of benign lesions,and the difference was statistically significant(P<0.001).The Emean,Emax,and Eratio values of HCC were all smaller than ICC,and the differences between Emean and Emax of the two groups were statistically significant(P<0.05).The Emean,Emax,and Eratio values of HCC were all smaller than MLC,and the differences between the two groups were statistically significant(P<0.05).Emean,Emax,and Eratio values of ICC were all less than MLC,but the difference between the two groups is not statistically significant(P>0.05).In the ROC of differential diagnosis of benign and malignant hepatic space occupying lesions,the AUC corresponding to Emean,Emax,Eratio were 0.760,0.841,and 0.765,respectively.The critical values for benign and malignant diagnosis were 29.30 kPa,41.63 kPa,and 3.91,respectively,and the sensitivity and specificity were 76.4 % and 67.2%,80.9% and 78.1%,78.7% and 64.1%.Conclusion:SWE can quantitatively assess the hardness information of hepatic space occupying lesions,and can provide new diagnostic ideas for the differential diagnosis of hepatic space occupying lesions.It has broad clinical application prospects.Part ? Application Value of Multimodal Ultrasound in Hepatic Space Occupying LesionsObjective:To analyze the sonographic features of conventional ultrasound(US),Contrast-Enhanced Ultrasound(CEUS),and Shear Wave Elastography(SWE)of hepatic space occupying lesions.The diagnostic efficacy of US,CEUS,SWE,and multimodal ultrasound for hepatic space occupying lesions are compared,so as to provide imaging theoretical basis for clinical diagnosis and treatment of hepatic space occupying lesions.Methods:US,CEUS,and SWE examinations were performed on 153 lesions of 131 patients in our hospital from December 2017 to December 2019.The results of pathological or imaging diagnosis were used as controls.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of US,CEUS,SWE,and multimodal ultrasound for the diagnosis of hepatic space occupying lesions were evaluated respectively.To evaluate the diagnostic efficacy of US,CEUS,SWE,and multimodal ultrasound in hepatic space occupying lesions.Results:The 153 lesions included 89 malignant and 64 benign.US diagnosed 85 malignant lesions and 68 benign diagnoses.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of differentiating benign and malignant lesions were 69.7%,64.1%,67.3%,and 72.9.%,60.3%,draw the ROC curve,and get the area under the curve(AUC)is 0.669;CEUS diagnosed 88 malignant lesions and 65 benign lesions.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the diagnosis were 91.0%,89.1%,90.2%,92.1%,and 87.7%,respectively.The AUC was 0.900;SWE was diagnosed with 86 malignant lesions and 67 benign lesions.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the diagnosis were 80.9%,78.1%,79.7%,83.7%,74.6%,and AUC were 0.841;There are 90 malignant lesions and 63 benign lesions diagnosed by multimodal ultrasound.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the diagnosis are 95.51%,92.19%,94.12%,94.44%,and 93.65%,AUC is 0.938.The diagnostic efficacy of CEUS is better than that of SWE and US,and the difference is statistically significant(P<0.05).The diagnostic efficacy of multimodal ultrasound is better than CEUS,and the difference is statistically significant(P<0.05).Conclusion:US,CEUS and SWE have a positive diagnostic value for the differential diagnosis of hepatic space occupying lesions.SWE is superior to US in the diagnosis of liver tumors,while CEUS is superior to SWE in the diagnosis of hepatic space occupying lesions.Multimodal ultrasound can provide more comprehensive information for the diagnosis of hepatic space occupying lesions,and has higher diagnostic efficacy,with higher diagnostic efficiency and better clinical application value.