Role of Ultrasound Shear-Wave Elastography in Differentiating Hepatocellular Carcinoma from Other Solid Hepatic Focal Lesions in Correlation with Triphasic CT Findings

Background: Improved screening and diagnostic tools have improved early detection of hepatocellular carcinoma (HCC), a leading cause of cancer-related death in Egypt, especially among high-risk patients with chronic viral hepatitis.
Aim: This study aimed to evaluate the diagnostic accuracy of stiffness values between hepatocellular carcinoma (HCC) and other solid hepatic focal lesions, as measured by shear wave elastography (SWE), and to correlate the results with triphasic computed tomography (CT) studies. Patients and methods: Thirty-four patients with localized liver lesions participated in this prospective observational study. Patients were collected from Cairo University's Faculty of Medicine's Clinical Oncology, Surgery, and Endemic Medicine Departments.
Results: SWE stiffness values showed no significant difference among benign lesions, but a significant difference among malignant ones, with HCC and metastases showing lower stiffness than cholangiocarcinoma (P < 0.001). SWE differentiated HCC from cholangiocarcinoma and focal fatty lesions (P < 0.001, 0.017), but not from metastases or hemangiomas. A significant association was found between lesion type and number, ascites, and splenomegaly. Only hemangiomas showed a significant correlation between stiffness and size (r = 0.848, P = 0.033). At a cutoff >18.6 kPa, SWE achieved 95.2% sensitivity and 84.6% specificity in distinguishing malignant from benign lesions (AUC = 0.886, P < 0.001).
Conclusion: SWE differentiated HCC from cholangiocarcinoma and focal fatty lesions but not from other lesions. It may help distinguish cholangiocarcinoma from HCC.