Can point shear wave elastography differentiate focal nodular hyperplasia from hepatocellular adenoma

Abstract

PurposeFocal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are liver tumors that require different management. We assessed the potential of point shear wave elastography (pSWE) to differentiate FNH from HCA and the interobserver and intraobserver reliability of pSWE in the examination of these lesions and of native liver tissue (NLT).MethodsThe study included 88 patients (65 FNH, 23 HCA). pSWE was performed by two experienced liver sonographers (observers 1 [O1] and 2 [O2]) and acquired within the lesion of interest and NLT. Group differences, optimal cutoff for characterization and interobserver reliability was assessed with Mann‐Whitney‐U, area under the ROC curce (AUROC) and intraclass correlation coefficient (ICC). Intraobserver reliability in NLT was assessed in 20 healthy subjects using ICC.ResultsMedian stiffness was significantly higher in FNH than in HCA (7.01 kPa vs 4.98 kPa for O1 (P = 0.017) and 7.68 kPa vs 6.00 kPa for O2 (P = 0.031)). A cutoff point for differentiation between the two entities could not be determined with an AUROC of 0.67 (O1) and 0.69 (O2). Interobserver reliability was good for lesion‐ stiffness (ICC = 0.86) and poor for NLT stiffness (ICC = 0.09). In healthy subjects, intraobserver reliability for NLT‐stiffness was poor for O1 (ICC = 0.23) and moderate for O2 (ICC = 0.62).ConclusionThis study shows that pSWE cannot reliably differentiate FNH from HCA. Interobserver and intraobserver reliability for pSWE in NLT were insufficient. Interpretation of results gained with this method should be done with great caution.

Diagnostic performance of endoscopic ultrasonography‐guided elastography for solid pancreatic lesions: Shear‐wave measurements versus strain elastography with histogram analysis

“…As a result, the measurement results may show discrepancies. Taimr 27 reported that elements such as the tumor margin, the presence of a capsule, and heterogeneity in the internal echo may appear as artifacts in SWM. Artifacts in the SWM of solid mass lesions have been reported to include capsule reverberation artifacts, penetration limitations or dropout artifacts, artifacts due to blood vessels, shadowing artifacts, tissue motion artifacts, and near‐field distortion/precompression artifacts 28–30 .…”

Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study

“…In the present study, the EUS-SWM system yielded a low reliability index (VsN) or measurement failure for extremely hard lesions with a heterogeneous structure such as fibrosis in a tumor. Various artifacts have been reported to appear due the position of the measurement ROI, effects of precompression by the probe, motion effect of the target lesion, and the heterogeneity in the focal mass of the lesion, with regard to hardness quantification via SW-EG [37–42].…”

Novel Strategy for Diagnosis of Focal Nodular Hyperplasia Using Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid: Enhanced Magnetic Resonance Imaging and Magnetic Resonance Elastography

“…Using this difference, we can differentiate HCA from FNH, despite it being atypical. Ultrasound elastography, which has become more popular in the recent years, also recognizes FNH as a stiffer mass than HCA, as in this case [ 5 ]. However, as mentioned above, MRE is more useful than ultrasound elastography because it can be used simultaneously for HCC screening and staging in Gd-EOB-DTPA-enhanced MRI.…”