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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

Q-analysis of SE of the tumor lesion.Two regions of interest (ROI`s) were placed in the center (turquoise, yellow), five ROIs in the surrounding liver tissue. Increased stiffness in the tumor center (level 4–5) in comparison to the liver tissue (level 1–3) (color coded line on left hand side). The lines document a continuous evaluation of the tissue stiffness over 10 seconds. High image quality was indicated by 5 green marks for SE.
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pone.0123737.g004: Q-analysis of SE of the tumor lesion.Two regions of interest (ROI`s) were placed in the center (turquoise, yellow), five ROIs in the surrounding liver tissue. Increased stiffness in the tumor center (level 4–5) in comparison to the liver tissue (level 1–3) (color coded line on left hand side). The lines document a continuous evaluation of the tissue stiffness over 10 seconds. High image quality was indicated by 5 green marks for SE.

Mentions: The elasticity index reflects the color distribution within a defined region of interest (ROI) and was set as a scale from 0.0 (soft) to 6.0 (hard). Static ROIs were chosen to be round in shape. Two were placed in the center of the tumor (turquois and yellow) and five in the surrounding tissue (red, white, pink, orange, green), ranging from 5–10 mm in diameter (Fig 4). These were located at the same depth as their corresponding tumor ROIs.


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)

Q-analysis of SE of the tumor lesion.Two regions of interest (ROI`s) were placed in the center (turquoise, yellow), five ROIs in the surrounding liver tissue. Increased stiffness in the tumor center (level 4–5) in comparison to the liver tissue (level 1–3) (color coded line on left hand side). The lines document a continuous evaluation of the tissue stiffness over 10 seconds. High image quality was indicated by 5 green marks for SE.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0123737.g004: Q-analysis of SE of the tumor lesion.Two regions of interest (ROI`s) were placed in the center (turquoise, yellow), five ROIs in the surrounding liver tissue. Increased stiffness in the tumor center (level 4–5) in comparison to the liver tissue (level 1–3) (color coded line on left hand side). The lines document a continuous evaluation of the tissue stiffness over 10 seconds. High image quality was indicated by 5 green marks for SE.
Mentions: The elasticity index reflects the color distribution within a defined region of interest (ROI) and was set as a scale from 0.0 (soft) to 6.0 (hard). Static ROIs were chosen to be round in shape. Two were placed in the center of the tumor (turquois and yellow) and five in the surrounding tissue (red, white, pink, orange, green), ranging from 5–10 mm in diameter (Fig 4). These were located at the same depth as their corresponding tumor ROIs.

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