Data from: Is strain elastography (IO-SE) sufficient for characterization of liver lesions before surgical resection - or is contrast enhanced ultrasound (CEUS) necessary?

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.

研究目的：评估术中超声弹性成像（IO-SE）与术中超声造影（IO-CEUS）鉴别肝脏良恶性病灶的诊断准确性。
材料与方法：本研究为回顾性诊断研究，对49个肝脏病灶的术中超声弹性成像与术中超声造影检查结果进行评估，并与组织病理学检查结果进行对比。超声检查采用多频线阵探头（6~9 MHz）。超声造影动态图像的评估时长可达5分钟。术中超声弹性成像的定性分析基于颜色编码系统：蓝色代表质地坚硬，红色代表质地柔软。所有病灶的硬度通过0~6的特定量化标尺进行量化（0代表硬度低，6代表硬度高），共选取7个感兴趣区（Region of Interest, ROI），其中2个位于病灶中央，5个位于病灶周边。
结果：所有恶性病灶均表现出特征性的门静脉期廓清现象，术中超声造影可对其作出正确诊断。5个良性病灶中有3个在手术切除前，无论通过术中超声造影还是术中超声弹性成像均无法准确定性。据此，术中超声造影的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率分别为100%、40%、94%、100%及94%。病灶直径介于8~59 mm之间。就术中超声弹性成像而言，恶性病灶表现出显著的硬度异质性。定性分析中，31个恶性病灶呈蓝色，提示整体质地坚硬；13个恶性病灶呈现不均匀的颜色分布，伴局部质地变硬。另有2个良性病灶也表现为整体质地坚硬，其余良性病灶则呈现不均匀的颜色映射。经计算，术中超声弹性成像的灵敏度为70.5%，特异度为60%，阳性预测值为94%，阴性预测值为18.75%，诊断准确率为69%。
结论：术中超声造影可用于手术切除前肝脏病灶的定位与定性诊断，而术中超声弹性成像仅能对有限数量的病灶作出准确定性。