The Clinical Research Of Real-time Shear Wave Elastography And Contrast Enhancmented Ultrasonography In Differential Diagnosis Of Focal Liver Lesions

Part ? The clinical research of real-time shear wave elastography in differential diagnosis of focal liver lesionsObjectiveTo evaluate the sonographic features of real time shear wave elastography ultrasonic imaging (SWE) in patients with focal liver lesions (FLLs). To investigate the clinical application value of SWE in differential diagnosis of benign and malignant FLLs.Methods122 patients in hospital from September 2012 to June 2015 with FLLs were included in the study, A total of 122 lesions were divided into two groups:the benign lesion group the malignant lesion group. There were 65 cases in the benign lesion group:hemangioma(ANGIs) 47 case, Hepatic adenoma (HAs) 10 case, Focal nodular hyperplasia(FNHs) 8 cases and 57 cases in the malignant lesion group:hepatocellular carcinoma (HCCs) 38 cases, metastatic liver cancer(MTs) totally 19 cases, including 11 colorectal liver metastases,3 esophageal cancer liver metastases and 5 breast cancer liver metastases. The diameter of lesions was 11-65mm (average 30.2±15.6mm), in which the diameter of the benign group was 11-65mm(average 29.6±12.9 mm) and the malignant group was 12-63mm(average 24.7±11.4 mm). All the FLLs were examined by SWE and The young's modulus mean elasticity value of them were obtained by SWE technique, All the FLLs were confirmed by pathologies in our hospital as the gold standard. SWE results were compared with the pathologies to evaluate the accuracy using SWE to diagnose the malignant and benign of FLLs.Results(1)Using SWE technique to diagnose FLLs, the mean elasticity value of Young's modulus was obtained. In the benign lesion group, the mean elasticity value of the Young's modulus was (21.55±7.54) kPa for ANGIs, (13.05±9.1) for HAs and (38.5±4.40) kPa for FNHs; in the malignant lesion group, mean elasticity value of the Young's modulus was (13.98+4.38) for HCCs and (24.97+7.26) kPa for MTs. There was significant difference between ANGIs and HAs, FNHs, HCCs (P<0.05), There was significant differences between HAs and ANGIs, FNHs, MTs (P<0.05), There was significant difference between MTs and HAs, ANGIs, FNHs (P<0.05), There were significant difference between FNHs and ANGIs, HAs, MTs and HCCs (P<0.05), There was significant differences between HCCs and and ANGs, FNHs, MTs (P<0.05);There was no significant difference between ANGIs and MTs (P>0.05),There was no significant difference between HAs and HCCs (P>0.05),The difference between the benign and the malignant lesion group was statistically significant (P<0.05).(2)The critical point of the mean elasticity value of Young's modulus between benign and malignant lesions was 16.300 by ROC curve, the sensitivity was 68.9% and specificity was 54.4%. The area under the ROC curve of FLLs was:63.3%.ConclusionSWE not only could diagnose the benign and malignant of FLLs, but also could identify specific type.SWE has certain value of clinical application.Part ? The clinical research of real time shear wave elastography and contrast enhancmented ultrasonography in differential diagnosis of focal liver lesionsObjectiveTo evaluate the imaging characteristics of the ultrasonic contrast (CEUS) and real time shear wave ultrasonic imaging (SWE) in the focal liver lesions (FLLs), To investigate and compare the clinical application value of CEUS, SWE and CEU+SWE in the differential diagnosis of benign and malignant FLLs.Methods122 patients in hospital from September 2012 to June 2015 with FLLs were included in the study, A total of 122 lesions were divided into two groups:the benign lesion group the malignant lesion group. There were 65 cases in the benign lesion group:hemangioma(ANGIs) 47 case, Hepatic adenoma (HAs) 10 case, Focal nodular hyperplasia(FNHs) 8 cases and 57 cases in the malignant lesion group:hepatocellular carcinoma (HCCs) 38 cases, metastatic liver cancer(MTs) totally 19 cases, including 11 colorectal liver metastases,3 esophageal cancer liver metastases and 5 breast cancer liver metastases. The diameter of lesions was 11-65mm (average 30.2± 15.6mm), in which the diameter of the benign group was 11-65mm(average 29.6±12.9 mm) and the malignant group was 12-63mm(average 24.7±11.4 mm). All of he FLLs were examined by conventional ultrasound, SWE and CEUS respectively, the mean elasticity value of the Young's modulus of FLLs was obtained by SWE technique and the CEUS image was obtained by CEUS. Using double blind method, SWE, CEUS and SWE+CEUS were used to analyze the benign and malignant of FLLs.All the FLLs were confirmed by pathologies (Biopsy/operation) in our hospital as the gold standard and the results were compared with them. We evaluated the accuracy of SWE, CEUS and SWE+CEUS in the diagnosis of benign and malignant FLLs, and investigated the diagnostic value of these three diagnostic techniques in FLLs.ResultsThe sensitivity, specificity and accuracy of SWE in the diagnosis of FLLs were 68.9%,54.4% and 61.5% respectively. The sensitivity, specificity and accuracy of CEUS in the diagnosis of FLLs were 81.5%,77.2% and 79.5% respectively, and when the two methods were combined, the sensitivity, specificity and accuracy in the diagnosis of FLLs were 93.8%,91.2% and 92.6% respectively. There was significant difference in the diagnostic accuracy in the diagnosis of benign and malignant FLLs between CEUS and SWE (p<0.05). There was significant difference in the diagnostic efficiency accuracy in the diagnosis of benign and malignant FLLs between CEUS+SWE and SWE (p<0.05), also significant difference in the diagnostic efficiency accuracy in the diagnosis of benign and malignant FLLs between CEUS and CEUS+SWE (p<0.05).ConclusionCEUS, SWE and CEUS+SWE have a certain clinical value in the diagnosis of FLLs. CEUS and CEUS+SWE are more accurate than SWE and CEUS+SWE is more accurate than CEUS. CEUS+SWE have the best accuracy in the diagnosis of FLLs. Because SWE and CEUS reflected different aspects of FLLs, when the two methods were combined, the diagnostic effciency was the highest. Besides CEUS, SWE can provide additional information for the characterization of FLLs.Part ? Analysis of influence factors on the elasticity measurement of focal liver lesions with real time shear wave elastographyObjectiveTo study the influence factors on the elasticity of FLLs measurement with SWE and provide the basis for the future development of appropriate clinical examination specifications.MethodsThe mean Young's modulus of 160 FLLs were measured by SWE.The relation between elasticity with different aspects of FLLs were analyzed including:the location (SI-SVIII segment), postures (supine and left lateral position), respiratory phases (end of inspiratory and expiratory), the probe position (rib and intercostal space) and different operators.ResultsIn this study we found that the locations of FLLs had a significant effect on the elasticity measurement of FLLs by SWE.There were statistically significant differences between different postures and respiratory phases in the elasticity measurement of FLLs by SWE (P<0.05). There were no relatively statistically significant differences between robe position and different operators in the elasticity measurement of FLLs by SWE (P> 0.05).ConclusionThe Loctions of FLLs can impact the elasticity measurement of FLLs by SWE, The elasticity measurement was also affected by postures and respiratory phases. Our results provided an important basis for the future development of appropriate clinical examination specifications and had important value for the future standardization of the FLLs elasticity measurement with SWE.