Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

Abstract

The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE.

Preliminary Clinical Experience with Shear Wave Dispersion Imaging for Liver Viscosity in Preoperative Diagnosis of Focal Liver Lesions

“…These findings can be explained from the histopathological point of view that malignant FLLs having higher cellularity, while benign lesions, such as hemangiomas, are composed of sinusoids [8]. In liver tumors, the architecture of tissue between benign and malignant FLLs can be totally different due to necrosis, hemorrhage, or colloid, such as in hemangioma or metastasis [17,34,35]. As previously reported, dispersion slope is more useful than shear-wave speed for predicting the degree of necroinflammation [27].…”

“…For malignant tumors, metastasis tumors showed the highest viscosity value. This might be explained by the significantly heterogeneous internal structure of metastasis liver lesions [17,35]. Necrosis, hemorrhage, and peliosis, which are frequent features of HCC, probably play a major role in the viscosity of these tumors as well as the occurrence of some fibrotic bands [15,18].…”

“…Some studies showed that SWE might also helpful in the differential diagnosis of benign and malignant FLLs [9,10], such as hemangioma versus liver metastases [10], focal nodular hyperplasia (FNH) versus hepatocellular adenoma (HCA) [11,12] and hepatocellular carcinoma (HCC) [13,14], and HCC versus cholangiocarcinoma [15]. However, the major drawback is the large overlap between SWE values in benign and malignant FLLs, thus limiting its clinical use [10,16,17]. Some of previous studies showed higher shear wave velocity values in malignant liver tumors [18]; others showed similar velocity values in benign and malignant liver tumors [19][20][21][22].…”

Multiparametric ultrasound in liver diseases: an overview for the practising clinician

“…For instance, hepatocellular carcinoma (HCC) commonly develops in cirrhotic livers and both the tumour and the non-infiltrated liver may be assessed by elastography during the same examination [34]. By using this approach liver elastography malignancy prediction (LEMP) score has recently been proposed and it was able to differentiate between benign and malignant tumours in 96.1% of cases [35]. This algorithm overcomes the limitations of elastography when only mean tumour stiffness is used.…”

“…In addition, the heterogeneity of tumour stiffness is appreciated and is also incorporated into the LEMP formula. A more simplified approach uses only dichotomized values of mean tumour stiffness (14 and 32.5 kPa) with a 96% negative and positive predictive value for malignancy, which is applicable in 55.6% of the patients, whereas 44.4% remain in the "grey zone" between these cut-off points [35]. Although innovative, this elastographic approach to FLL is time consuming, and should be validated in independent cohort.…”