Korean J Radiol.  2013 Oct;14(5):743-753. 10.3348/kjr.2013.14.5.743.

Acoustic Radiation Force Impulse Elastography for Focal Hepatic Tumors: Usefulness for Differentiating Hemangiomas from Malignant Tumors

• Kim JE
• Lee JY
• Bae KS
• Han JK
• Choi BI

• KMID: 1711428
• DOI: http://doi.org/10.3348/kjr.2013.14.5.743

Abstract

OBJECTIVE
The purpose of this study is to investigate whether acoustic radiation force impulse (ARFI) elastography with ARFI quantification and ARFI 2-dimensional (2D) imaging is useful for differentiating hepatic hemangiomas from malignant hepatic tumors.
MATERIALS AND METHODS
One-hundred-and-one tumors in 74 patients were included in this study: 28 hemangiomas, 26 hepatocellular carcinomas (HCCs), three cholangiocarcinomas (CCCs), 20 colon cancer metastases and 24 other metastases. B-mode ultrasound, ARFI 2D imaging, and ARFI quantification were performed in all tumors. Shear wave velocities (SWVs) of the tumors and the adjacent liver and their SWV differences were compared among the tumor groups. The ARFI 2D images were compared with B-mode images regarding the stiffness, conspicuity and size of the tumors.
RESULTS
The mean SWV of the hemangiomas was significantly lower than the malignant hepatic tumor groups: hemangiomas, 1.80 +/- 0.57 m/sec; HCCs, 2.66 +/- 0.94 m/sec; CCCs, 3.27 +/- 0.64 m/sec; colon cancer metastases, 3.70 +/- 0.61 m/sec; and other metastases, 2.82 +/- 0.96 m/sec (p < 0.05). The area under the receiver operating characteristics curve of SWV for differentiating hemangiomas from malignant tumors was 0.86, with a sensitivity of 96.4% and a specificity of 65.8% at a cut-off value of 2.73 m/sec (p < 0.05). In the ARFI 2D images, the malignant tumors except HCCs were stiffer and more conspicuous as compared with the hemangiomas (p < 0.05).
CONCLUSION
ARFI elastography with ARFI quantification and ARFI 2D imaging may be useful for differentiating hepatic hemangiomas from malignant hepatic tumors.

Keyword

Acoustic radiation force impulse imaging; ARFI; Elastography; Ultrasound; Liver; Tumors

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/*ultrasonography
Diagnosis, Differential
Elasticity Imaging Techniques/*methods
Female
Hemangioma/*ultrasonography
Humans
Liver/*ultrasonography
Liver Neoplasms/*ultrasonography
Male
Middle Aged
ROC Curve
Reproducibility of Results

Figure

• 

  Fig. 1 Combined box-and-whisker and dot plots of median shear wave velocity (SWV) (m/sec, y-axis) among five hepatic tumor groups (x-axis). HCC = hepatocellular carcinoma, CCC = cholangiocarcinoma

• 

  Fig. 2 Receiver operating characteristic curves of median shear wave velocity (SWV) for differentiating hepatic hemangiomas from malignant hepatic tumors.

• 

  Fig. 3 Hemangioma with same color and worse conspicuity on acoustic radiation force impulse (ARFI) 2-dimensional (2D) image of 55-year-old male. A. This isoechoic hemangioma shows same stiffness as adjacent hepatic parenchyma on ARFI 2D image. Lesion conspicuity is worse on ARFI 2D image because of poor delineation of hyperechoic rim. B. Size of lesion is same on both images. C, D. Median shear wave velocity (SWV) of this hemangioma was 1.25 m/sec and mean SWV difference was 0.08 m/sec. Scales provided by dots in right vertical axis of B-mode images are in centimeters.

• 

  Fig. 4 Rectal cancer metastasis with remarkably darker color and better conspicuity on acoustic radiation force impulse (ARFI) 2-dimensional (2D) image of 49-year-old male. A, B. This metastatic tumor from rectal cancer is remarkably stiffer than adjacent hepatic parenchyma on ARFI 2D image. Conspicuity of this isoechoic metastasis is better on ARFI 2D image. C, D. Median shear wave velocity (SWV) of this tumor was 3.19 m/sec, and mean SWV difference was 2.03 m/sec. Scales provided by dots in right vertical axis of B-mode images are in centimeters.

• 

  Fig. 5 Hepatocellular carcinoma (HCC) with same color and worse conspicuity on conspicuity on acoustic radiation force impulse (ARFI) 2-dimensional (2D) image of 69-year-old male with chronic liver disease. A, B. This HCC shows same stiffness as adjacent chronic liver disease parenchyma on ARFI 2D image. Conspicuity of this hypoechoic HCC is worse on ARFI 2D image. C, D. Median shear wave velocity (SWV) of this HCC and hepatic parenchyma was 1.90 m/sec and 2.39 m/sec, and SWV difference was -0.49 m/sec. Scales provided by dots in right vertical axis of B-mode images are in centimeters.

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