Ultrasonic Elastography Of Focal Liver Lesions And Contrast Research Of Ultrasonic Elastography And Contrast-Enhanced Ultrasound(CEUS)

Objective The volunteers and patients with focal liver lesions underwentultrasonic elastography and CEUS, to summarize the characteristics of focal liverlesions on this two imaging, explore the value of Ultrasonic Elastography and CEUSin differential diagnosis of focal liver lesions, and expect to raise the accuracy ofultrasound for focal liver lesions, especially for the small lesions.Methods1.184patients with202focal liver lesions and15healthy volunteers underwentvirtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ).Observed parameters on the elastography images are the lesions boundary, theuniformity of echo in the lesions, echo intensity and the size on the VTI elastographicimage and corresponding B-mode image. The shear wave velocity(SWV) of lesionsand liver parenchyma were obtained by conducted VTQ. We record the lesionsmaximal, minimum, mean value, the diference and relative value of the maximal andminimum value, the SWV of liver parenchyma and the diference between the lesionsand liver parenchyma.2.71patients with80focal liver lesions among the subjects were examined with grayscale CEUS and40patients had hepatic artery to vein transit time(HAVTT)measuremented. The diagnostic criteria of CEUS refer to <Guidelines and GoodClinical Practice Recommendations for CEUS-Update2008> of europe.3. The results of ultrasonic elastography and CEUS were compared.4. The results were statistically analyzed with P＜0.05indicating siginificantdiffererces.Result1. The results of ultrasonic elastography displayed that the stiffness of malignantgroup was highest, followed by benign group and then normal group(P＜0.05). With acut-off value of2.08m/s for the SWV, the sensitivity, specificity and accuracy was 90.3%,76.9%and84.2%, respectively. Poorly differentiated HCCs were stiffer thanmoderately differentiated HCCs and well-differentiated HCCs(P＜0.05).2. Benign focal liver lesions could stiffer or softer than the background liver or hadidentical stiffness compared with background liver. The tissue texture of benign focalliver lesions was even.The size of benign focal liver lesions on the VTI elastographicimages was equal to corresponding B-mode images’. The typically VTI elastographicimages of hemangioma was looked like honeycomb appearance. Malignant focal liverlesions appeared stiffer than the background liver. The size of malignant focal liverlesions on the VTI elastographic images was larger than corresponding B-modeimages’. The homogeneity of malignant lesions’ texture was related to the lesions’size. The larger of the lesion’s size, the more uneven of the texture. The typically VTIelastographic image of liver metastatic carcinoma lesion was looked like bovine eye.3. The accuracy rate of the gray scale CEUS was92.5%. Our study marked HAVTT1≤10.5s as the differentiating diagnostic crierria of benign and malignancy FLLs, thesensitivity, specificity and accuracy were82.1%,83.3%,82.5%, respectively. Thegray scale CEUS was more useful than determinated HAVTT in differential diagnosisof focal liver lesions.Conclusions ARFI elastography can reflect the stiffness of focal liver lesionsobjectivelly, and it’s useful for the differential diagnosis of focal liver lesions. Grayscale CEUS revealed the lesion’s changes of blood supply in microcirculation, and it’smore useful than ARFI elastography. But ARFI elastography is useful in differentialdiagnosis of focal liver lesions which is hard to diagnisis by gray scale CEUS. Grayscale CEUS and ultrasonic elastography have complementary effect in the differentialdiagnosis of focal liver lesions, combined both methods can raise the accuracy of ofultrasound for focal liver lesions.