Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2017; 23(30): 5602-5609
Published online Aug 14, 2017. doi: 10.3748/wjg.v23.i30.5602
Combination of acoustic radiation force impulse imaging, serological indexes and contrast-enhanced ultrasound for diagnosis of liver lesions
Xiao-Lan Sun, Hui Yao, Qiong Men, Ke-Zhu Hou, Zhen Chen, Chang-Qing Xu, Li-Wei Liang
Xiao-Lan Sun, Department of Ultrasound, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Hui Yao, Department of Radiotherapy, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Qiong Men, Department of Oncology, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Ke-Zhu Hou, Department of Surgery, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Zhen Chen, Department of Pathology, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Chang-Qing Xu, Department of Radiography, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Li-Wei Liang, Department of Gastroenterology, Shanghai Yangpu District East Hospital, Shanghai 200433, China
Author contributions: Sun XL and Liang LW designed the research; Sun XL, Yao H, Men Q, Hou KZ and Liang LW performed the research; Sun XL, Yao H, Men Q, Hou KZ, Chen Z, Xu CQ and Liang LW contributed new reagents or analytic tools; Sun XL, Hou KZ, Chen Z, Xu CQ and Liang LW analyzed the data; Sun XL and Liang LW wrote the paper.
Supported by Yangpu District Health and Family Planning Commission, Yangpu District Science and Technology Commission, No. YP15M18; Research Project of Shanghai Municipal Commission of Health and Family Planning, No. 201540032.
Institutional review board statement: This study was approved by Shanghai Yangpu District East Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article are reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Li-Wei Liang, Attending Physician, Department of Gastroenterology, Shanghai Yangpu District East Hospital, No. 999 Shiguang Road, Yangpu District, Shanghai 200433, China. ypsdkjk@163.com
Telephone: +86-21-65881977
Received: March 27, 2017
Peer-review started: March 29, 2017
First decision: April 11, 2017
Revised: April 24, 2017
Accepted: May 9, 2017
Article in press: May 9, 2017
Published online: August 14, 2017
Processing time: 139 Days and 11.3 Hours
Abstract
AIM

To assess the value of combined acoustic radiation force impulse (ARFI) imaging, serological indexes and contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant liver lesions.

METHODS

Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions.

RESULTS

A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity (SWV) value, serum alpha-fetoprotein (AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group (2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/mL vs 15.96 ± 4.33 ng/mL, 2.14 ± 0.21 dB/s vs 2.01 ± 0.31 dB/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves (AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.

CONCLUSION

The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.

Keywords: Combined diagnosis; Liver lesions; Benign; Malignant; Differentiation

Core tip: This study investigated the diagnostic value of combined acoustic radiation force impulse (ARFI) imaging, serological indicators and contrast-enhanced ultrasound in differentiating between benign and malignant liver lesions. The results showed that the diagnostic performance of combined ARFI, alpha-fetoprotein (AFP) and contrast-enhanced ultrasound in distinguishing between benign and malignant liver lesions was higher than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.