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Is Strain Elastography (IO-SE) Sufficient for Characterization of Liver Lesions before Surgical Resection--Or Is Contrast Enhanced Ultrasound (CEUS) Necessary?

Jung EM, Platz Batista da Silva N, Jung W, Farkas S, Stroszczynski C, Rennert J - PLoS ONE (2015)

Bottom Line: The other benign lesions showed an inhomogenous color mapping.Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Regensburg, Department of Radiology, Regensburg, Germany.

ABSTRACT

Aim: To evaluate the diagnostic accuracy of IO-SE in comparison to IO-CEUS for the differentiation between malignant and benign liver lesions.

Material and methods: In a retrospective diagnostic study IO-CEUS and SE examinations of 49 liver lesions were evaluated and compared to histopathological examinations. Ultrasound was performed using a multifrequency linear probe (6-9 MHz). The loops of CEUS were evaluated up to 5 min. The qualitative characterization of IO-SE was based on a color coding system (blue = hard, red = soft). Stiffness of all lesions was quantified by a specific scaling of 0-6 (0 = low, 6 = high) using 7 ROIs (2 central, 5 peripheral).

Results: All malignant lesions displayed a characteristic portal venous washout and could be diagnosed correctly by IO-CEUS. 3/5 benign lesions could not be characterized properly either by IO-CEUS or IO-SE prior to resection. Thus for IO-CEUS sensitivity, specificity, positive and negative predictive value and accuracy were 100%, 40%, 94%, 100% and 94%. Lesion sizes were between 8 and 59 mm in diameter. Regarding the IO-SE, malignant lesions showed a marked variability. In qualitative analysis, 31 of the malignant lesions were blue colored denoting overall induration. Thirteen malignant lesions showed an inhomogenous color pattern with partial indurations. Two of the benign lesions also displayed overall induration. The other benign lesions showed an inhomogenous color mapping. Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.

Conclusion: IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

No MeSH data available.


Related in: MedlinePlus

Intraoperative B-mode and strain elastography (SE) in a case of metastatic breast carcinoma.Displayed is a high quality image of SE with subsequent green quality bars. Echo inhomogeneous tumor lesion in B-mode (left), enhanced stiffness (dark gray) in SE (right) in comparison to the surrounding liver tissue (light gray).
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pone.0123737.g003: Intraoperative B-mode and strain elastography (SE) in a case of metastatic breast carcinoma.Displayed is a high quality image of SE with subsequent green quality bars. Echo inhomogeneous tumor lesion in B-mode (left), enhanced stiffness (dark gray) in SE (right) in comparison to the surrounding liver tissue (light gray).

Mentions: The first step in analysis of the resulting elastography images was a qualitative characterization: the images were displayed using a 256-color map of strain using a scale from red (high strain, soft) to blue (low strain, hard) (Fig 3).


Is Strain Elastography (IO-SE) Sufficient for Characterization of Liver Lesions before Surgical Resection--Or Is Contrast Enhanced Ultrasound (CEUS) Necessary?

Jung EM, Platz Batista da Silva N, Jung W, Farkas S, Stroszczynski C, Rennert J - PLoS ONE (2015)

Intraoperative B-mode and strain elastography (SE) in a case of metastatic breast carcinoma.Displayed is a high quality image of SE with subsequent green quality bars. Echo inhomogeneous tumor lesion in B-mode (left), enhanced stiffness (dark gray) in SE (right) in comparison to the surrounding liver tissue (light gray).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482620&req=5

pone.0123737.g003: Intraoperative B-mode and strain elastography (SE) in a case of metastatic breast carcinoma.Displayed is a high quality image of SE with subsequent green quality bars. Echo inhomogeneous tumor lesion in B-mode (left), enhanced stiffness (dark gray) in SE (right) in comparison to the surrounding liver tissue (light gray).
Mentions: The first step in analysis of the resulting elastography images was a qualitative characterization: the images were displayed using a 256-color map of strain using a scale from red (high strain, soft) to blue (low strain, hard) (Fig 3).

Bottom Line: The other benign lesions showed an inhomogenous color mapping.Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Regensburg, Department of Radiology, Regensburg, Germany.

ABSTRACT

Aim: To evaluate the diagnostic accuracy of IO-SE in comparison to IO-CEUS for the differentiation between malignant and benign liver lesions.

Material and methods: In a retrospective diagnostic study IO-CEUS and SE examinations of 49 liver lesions were evaluated and compared to histopathological examinations. Ultrasound was performed using a multifrequency linear probe (6-9 MHz). The loops of CEUS were evaluated up to 5 min. The qualitative characterization of IO-SE was based on a color coding system (blue = hard, red = soft). Stiffness of all lesions was quantified by a specific scaling of 0-6 (0 = low, 6 = high) using 7 ROIs (2 central, 5 peripheral).

Results: All malignant lesions displayed a characteristic portal venous washout and could be diagnosed correctly by IO-CEUS. 3/5 benign lesions could not be characterized properly either by IO-CEUS or IO-SE prior to resection. Thus for IO-CEUS sensitivity, specificity, positive and negative predictive value and accuracy were 100%, 40%, 94%, 100% and 94%. Lesion sizes were between 8 and 59 mm in diameter. Regarding the IO-SE, malignant lesions showed a marked variability. In qualitative analysis, 31 of the malignant lesions were blue colored denoting overall induration. Thirteen malignant lesions showed an inhomogenous color pattern with partial indurations. Two of the benign lesions also displayed overall induration. The other benign lesions showed an inhomogenous color mapping. Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.

Conclusion: IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

No MeSH data available.


Related in: MedlinePlus