Elastography of background liver in patients with focal hepatic lesions undergoing Triple Phase CT and its correlation with LI-RADS
Main Article Content
Keywords
Elastography, LI-RADS, focal hepatic lesions, liver stiffness, triple-phase CT
Abstract
Differentiating between benign and malignant focal hepatic lesions in patients with chronic liver disease is critical for appropriate management. While imaging modalities such as triple-phase Computed Tomography (CT) and the Liver Imaging Reporting and Data System (LI-RADS) provide structured approaches for lesion characterization, they primarily focus on lesion morphology and enhancement patterns, often overlooking the role of the background liver parenchyma. Background liver stiffness assessment using elastography may provide additional insights in lesion characterization, particularly in cases where lesion enhancement patterns are atypical due to cirrhosis-related perfusion changes. This study evaluates the correlation between elastography-derived liver stiffness measurements and LI-RADS categorization of focal hepatic lesions identified on triple-phase CT.
Results: The majority of patients were in the 50–69 year age group (55.77%), with males comprising 61.54% of the study population. Liver stiffness values increased progressively with higher LI-RADS categories, with LR-TIV lesions exhibiting the highest mean stiffness (19.72 kPa). Spearman’s rank correlation demonstrated a strong positive relationship between LI-RADS categories and liver stiffness measurements (ρ = 0.79, p = 0.036). In addition, a Chi-square test for association showed a statistically significant relationship between categorized liver stiffness levels and LI-RADS categories (χ² = 36.15, p = 0.00031).
Conclusion: Elastography-derived liver stiffness correlates significantly with LI-RADS categorization, supporting its use as an adjunctive biomarker for focal hepatic lesion assessment. Integrating elastography with LI-RADS classification enhances diagnostic accuracy and may reduce the need for invasive biopsies. Further studies are warranted for validation in larger cohorts.
References
2. Cunha GM, Fowler KJ. Imaging diagnosis of hepatocellular carcinoma: LI-RADS. Chin Clin Oncol. 2021;10(5):47.
3. American College of Radiology. Liver Imaging Reporting and Data System (LI-RADS) version 2018. American College of Radiology; 2018.
4. Kim YK, Choi JY, Kim CS, Han YM, Lee YH. Cirrhosis-related hemodynamic changes and their impact on hepatic lesion characterization. Abdom Radiol (NY). 2019;44(3):870-882.
5. Lee MJ. A review of liver fibrosis and cirrhosis regression. J Pathol Transl Med. 2023;57(4):189-195.
6. Bota S, Șirli R, Sporea I, Focsa M, Popescu A, Danila M, et al. A new scoring system for prediction of fibrosis in chronic hepatitis C. Hepat Mon. 2011;11(7):548-555. doi:10.5812/kowsar.1735143X.767.
7. Zougmoré HT, Cadranel JF, Fantognon G, Azzi B, Smadhi R, Ngele Efole JR, et al. FibroScan® and shear wave correlated well in hepatic fibrosis evaluation of patients with chronic liver diseases in real-life situations. Medicine (Baltimore). 2022;101(32):e29612.
8. Li Y, Li Q, Mo F, Zhang Y, Chen S, Wang L, et al. Can risk stratification based on ultrasound elastography assist CEUS LI-RADS in diagnosing hepatocellular carcinoma? Front Oncol. 2021;11:662680.
9. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med. 2017;38(4):e16-e47. doi:10.1055/s-0043-103952. Erratum in: Ultraschall Med. 2017;38(4):e48. doi:10.1055/a-0641-0076. PMID:28407655.
10. Radonjić T, Dukić M, Jovanović I, Zdravković M, Mandić O, Popadić V, et al. Aging of liver in its different diseases. Int J Mol Sci. 2022;23(21):13085. doi:10.3390/ijms232113085.
11. Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention, and management. Nat Rev Gastroenterol Hepatol. 2019;16(10):589-604. doi:10.1038/s41575-019-0186-y.
12. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. J Hepatol. 2021;75(1):182-194. doi:10.1016/j.jhep.2020.11.005.
13. Chen X, Zhang J, Ruan W, Xu X, Zhu Y, Liu Y, et al. Sex-related disparities in hepatocellular carcinoma: the influence of hormonal and immunological differences. Front Immunol. 2022;13:939631. doi:10.3389/fimmu.2022.939631.
14. Cheng S, Chen C, Liu Y, Zhang H, Xu E, Wang W, et al. Pathological considerations of CEUS LI-RADS: correlation with fibrosis stage and tumour histological grade. Eur Radiol. 2021;31(6):4037-4047. doi:10.1007/s00330-020-07660-5.
15. Sarı O, Öztürk M, Balcı A, Çolak S, Tolu İ. An investigation of the efficacy of shear wave elastography in the characterization of focal liver lesions. Pol J Radiol. 2023;88:145-155. doi:10.12659/PJR.937660.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Vagisha Dahiya
Junior Resident, Radiology department, Sharda Hospital, SMS & R
Dr. Subhendu Mohanty
Associate Professor, Department of Medicine, Sharda Hospital, SMS & R
Dr. Rupanshi Jain
Senior Resident, Radiology department, Sharda Hospital, SMS & R
Dr. Khemendra Kumar
Professor, Radiology Department, Sharda Hospital, SMS & R [email protected], 9971461185
