Is There a Place for Elastography in the Diagnosis of Hepatocellular Carcinoma?

Abstract

Background and Aims: Elastography can provide information regarding tissue stiffness (TS). This study aimed to analyze the elastographic features of hepatocellular carcinoma (HCC) and the factors that influence intratumoral elastographic variability in patients with liver cirrhosis. Methods: This prospective study included 115 patients with liver cirrhosis and hepatocellular carcinoma evaluated between June 2016–November 2019. A total of 88 HCC nodules visualized in conventional abdominal ultrasound (US) met the inclusion criteria and underwent elastographic evaluation. Elastographic measurements (EM) were performed in HCC and liver parenchyma using VTQ (Virtual Touch Quantification), a point shear wave elastography (pSWE) technique. In all patients, we performed contrast-enhanced ultrasound (CEUS), and the final diagnosis of HCC was established by contrast-enhanced-CT or contrast-enhanced-MRI. Results: The mean VTQ values in HCCs were 2.16 ± 0.75 m/s. TS was significantly lower in HCCs than in the surrounding liver parenchyma 2.16 ± 0.75 m/s vs. 2.78 ± 0.92 (p < 0.001). We did not find significant differences between the first five and the last five EM, and the intra-observer reproducibility was excellent ICC: 0.902 (95% CI: 0.87–0.950). However, the tumor size, heterogeneity, and depth correlated with higher intralesional stiffness variability (p < 0.001). Conclusions: VTQ brings additional information for HCC characterization. Intra-observer reproducibility for both HCC and liver parenchyma was excellent. Knowing the stiffness of HCC’s might endorse an algorithm-based approach towards focal liver lesions (FLLs) in liver cirrhosis.

The Clinical Value of Multimodal Ultrasound for the Differential Diagnosis of Hepatocellular Carcinoma from Other Liver Tumors in Relation to Histopathology

“…This could be explained by the fact that we predominantly included large hepatocellular carcinomas in which necrosis and hemorrhage are frequent and could influence stiffness values [50]. The Vs was significantly lower in HCC than the background parenchyma in cirrhotic patients, consistent with results from other studies [46,51].…”

“…In previous research, the shear wave velocity value of HCCs ranged from 2.15 m/s ± 0.75 m/s to 3.07 ± 0.89 m/s [46,49]. Our results showed lower values than previously reported.…”

“…Based on the theory that a hepatocellular carcinoma is a soft tumor in contrast to the firm consistency of cirrhotic liver, as well as the hypothesis that liver metastases and cholangiocarcinomas are stiff lesions due to their desmoplastic stromal response, elastography can provide complementary information regarding tumoral stiffness and help in the differential diagnosis [45,46]. Our study found a statistically significant difference in SWM values between HCCs and non-HCC malignant tumors (1.59 ± 0.29 m/s.…”

Multiparametric Ultrasound Approach Using a Tree-Based Decision Classifier for Inconclusive Focal Liver Lesions Evaluated by Contrast Enhanced Ultrasound

“…In the same algorithm, the authors evaluating tumor stiffness offer a cutoff for "liver elsatography malignancy prediction (LEMP)" that would strongly suggest malignancy. Despite the potential benefit of tumor stiffness evaluation [22] in some tumors (such as HCC), we believe that further studies are needed in order to establish a cutoff that will take into consideration the dimension, type, and liver background of a tumor; nevertheless, LEMP could be integrated into further algorithms. Aside from the proposed practical algorithm, we investigated more CEUS parameters in the late phase with the help of TIC for depicting malignancy and PI for lesion type, thus objectively quantifying washout and wash-in flags.…”

Mapping the strain-stiffening behavior of the lung and lung cancer at microscale resolution using the crystal ribcage

“…Although elastography encompasses a broad range of techniques for assessing the material properties of biological tissues, each method presents limitations when addressing our specific problem ( Costa, 2004 ; De et al, 2010 ; Evans et al, 2012 ; Goenezen et al, 2012 ; Kennedy et al, 2014 ; Garra, 2015 ; Schregel et al, 2018 ; Seidl et al, 2020 ; Silva et al, 2020 ; Ghiuchici et al, 2021 ; Kuo et al, 2021 ; Wang et al, 2023 ). The gold-standard method for microscale elastography is atomic-force microscopy ( Krieg et al, 2018 ), which boasts extremely high-resolution, absolute measurements of stiffness.…”