Acoustic radiation force impulse quantification/imaging in differential diagnosis of benign and malignant liver tumors

Objective: To assess the value of acoustic radiation force impulse (ARFI) quantification/imaging in focal liver lesion (FLL) characterization. Material and methods: The study included 57 patients with 59 FLL. The final diagnosis based on the results of morphological examination (resected parts of the liver, biopsy samples) in 42 patients and on MRI/CT data - in 15 patients. There were 19 benign FLL (cavernous hemangioma - 7, focal nodular hyperplasia - 9, hepatocellular adenoma - 3) and 40 malignant FLL (liver metastases - 7, hepatocellular carcinoma - 9, hepatoblastoma - 15, cholangiocarcinoma - 6, embryonal sarcoma - 3). ARFI-quantification of FLL and liver tumors surrounding parenchyma was performed in all patients, ARFI-imaging of FLL in 41 patients with the use of Acuson S2000 ultrasound machine (Siemens, Germany) with a convex transducer (1-6 MHz). Results: The FLL stiffness measurement was unsuccessful in 2 of 59 (3.4%) cases (cholangiocarcinoma and focal nodular hyperplasia). Therefore, the final analysis of ARFI-quantification results was carried out for 57 FLL in 56 patients. Malignant FLL were significant stiffer in compare with benign FLL (shear wave velocity median was 2.700 m/s, interquartile range - 2.150-3.360 m/s versus 1.925 m/s and 1.280-2.780 m/s, respectively) (P = 0.0113). The optimal cut-off value of shear wave velocity for differential diagnosis of malignant and benign FLL was 2.05 m/s (AUC - 0.710, sensitivity - 82.1%, specificity - 66.1%). The significant difference in liver tumors surrounding parenchyma stiffness in patient with malignant and benign FLL were obtained (1.500 m/s and 1.228-2.043 m/s versus 1.165 m/s and 0.980-1.340 m/s, respectively) (P < 0.0011). The difference of FLL stiffness/liver tumors surrounding parenchyma stiffness ratio between malignant and benign FLL was insignificant (1.660 and 1.150-2.403 versus 1.880 and 1.390-2.230, respectively) (P = 0.7508). ARFI-imaging had no additional advantages over the combined use of B-mode and ARFI-quantification. Conclusion: ARFI-quantification/imaging has limited value in benign and malignant FLL characterization. Further prospective studies in this direction are required.

ARFI-эластография, ARFI-эластометрия

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