Diagnostic Accuracy of Shear Wave Elastography to Differentiate Solid Hepatic Lesions in Benign and Malignant Lesions

Abstract

Objective: To determine the diagnostic accuracy of shear wave elastography (SWE) to differentiate solid hepatic lesions in benign and malignant lesions using triphasic computed tomography (CT) scan and histopathology as standard methods.

Methodology: This descriptive cross-sectional study was conducted in Radiology Department, Dr Ruth K.M. Pfau Civil Hospital Karachi from March to September 2023. Elastography was performed on 96 patients with at least single solid hepatic lesion >1cm in diameter within depth of <5cm from hepatic capsule. Elastography findings were compared with triphasic CT scan and histopathology. The primary performance outcome of SWE were determined in term of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy against triphasic CT scan and histopathology.

Results: Out of 96 patients, 51 (53.1%) were males and 45 (46.9%) were females with a mean age of 50.31±11.29 years (Range: 18-70 years). The mean size and depth of the focal hepatic lesion was 4.3 ± 0.92 cm and 3.5 ± 1.2 cm. Cholangiocarcinoma was the stiffest malignant lesion with mean stiffness of 30.5±8.53kPa while the focal nodular hyperplasia was the stiffest benign lesion with mean stiffness of 13.65 ± 5.36kPa. Overall sensitivity, specificity, PPV, NPP and diagnostic accuracy of SWE in diagnosis of focal hepatic lesions were 93.9%, 83.3%, 92.5%, 86.2% and 90.6% respectively with cutoff value of 14.0 kPa.

Conclusion: SWE found to be a useful and easy non-invasive imaging modality to distinguish between benign and malignant focal hepatic lesions with high sensitivity, specificity and NPV, which aid in reliable exclusion of malignancy.