Role of Acoustic Radiation Force Impulse Elastography in the Characterization of Focal Solid Hepatic Lesions

The role of contrast-enhanced ultrasound in the evaluation of hepatobiliary lesions and its correlation with pathological findings

Purpose

To evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in assessing hepatobiliary lesions, and to correlate the findings of CEUS for hepatobiliary lesions with those of pathological examination performed through fine needle aspiration.

Material and methods

This prospective observational study included 50 patients with hepatobiliary lesions, who were referred for CEUS. The findings of CEUS were correlated with pathological findings.

Results

CEUS was determined to be a highly sensitive and specific imaging modality for the detection and characterization of hepatobiliary lesions, with the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS being 100.0%, 96.8%, 66.7%, 100.0%, and 96.7%, respectively, when correlated with pathological findings.

Conclusions

CEUS is a highly sensitive and specific imaging modality for the detection and characterization of hepatobiliary lesions, with wide availability in the present scenario.

Elastography for characterization of focal liver lesions: current evidence and future perspectives

Focal liver lesions (FLLs) are a common finding during routine abdominal ultrasound (US). The differential diagnosis between diverse types of FLLs, especially between benign and malignant ones, is extremely important and can often be particularly challenging. Radiological techniques with contrast administration and/or liver biopsy are mostly necessary for establishing diagnosis, but they have several contraindications or complications. Due to limitations of these tools, there is urgent and still unmet need to develop a first line, non-invasive and simple method to diagnose FLLs. Elastography is an US-based imaging modality that provides information about the physical parameter corresponding to the tissue stiffness and can be considered a virtual biopsy. Several elastographic approaches have been developed, such as transient elastography, strain imaging and share wave imaging, which include point shear wave elastography and 2D shear wave elastography. These tools are already in use for evaluating liver fibrosis and in the assessment of focal lesions in other organs, like breast and thyroid gland. This review aims to assess the current evidence of different techniques based on elastography in the setting of FLLs, in order to evaluate accuracy, limitations and future perspectives. In particular, we focused on two contexts: the ability of discriminating between benign and malignant lesions, especially hepatocellular carcinoma and liver metastasis, and the surveillance after percutaneous therapy. This could have a high clinical impact making elastography crucial to identify the appropriate management of FLLs.

Therapeutic effect of entecavir combined with compound Biejia Ruangan tablets on liver fibrosis

BACKGROUND

Chronic hepatitis B (CHB) patients often suffer from chronic inflammatory stimulation for a long time and are prone to liver fibrosis. Antiviral therapy combined with traditional Chinese medicine is the main treatment for liver fibrosis. Acoustic radiation force imaging (ARFI) can be used to quantitatively evaluate the hardness of the liver, thus providing an imaging means for clinical noninvasive evaluation of anti-fibrosis effect.

AIM

To evaluate the therapeutic effect of entecavir combined with compound Biejia Ruangan tablets on CHB liver fibrosis by ARFI.

METHODS

Ninety-two patients with CHB liver fibrosis were selected as study subjects. All patients were treated with entecavir combined with compound Biejia Ruangan tablets. ARFI was performed before and after treatment. Meanwhile, the indexes of serum liver fibrosis and liver function were measured before and after treatment. The results were compared with those of liver biopsy.

RESULTS

After treatment, serum alanine aminotransferase and aspartate aminotransferase, hyaluronic acid, type IV collagen, and laminin, and ARFI value decreased significantly (P < 0.05). ARFI values were positively correlated with the stages of liver fibrosis before and after treatment (r = 0.82, 0.84, P < 0.05).

CONCLUSION

ARFI can accurately reflect the change of CHB liver fibrosis degree before and after treatment of entecavir and compound Biejia Ruangan tablets, and provides a new imaging method for curative effect evaluation.