title: Focal nodular hyperplasia and hepatocellular adenoma: The value of shear wave elastography for differential diagnosis.
abstract: OBJECTIVE
  This study assessed the clinical usefulness of shear wave elastography (SWE) during ultrasound for differentiating between focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HAs).
  
  
  METHODS
  SWE was performed on 56 patients presenting with 76 liver lesions (57 FNHs and 19HAs) that were confirmed by MRI and contrast-enhanced ultrasound (CEUS) (n=55) or by histology (n=21). A mean elasticity value was obtained for each lesion. The ratios of the elasticity of the lesions to the elasticity of the surrounding liver were determined. The optimal elasticity cut-off value for distinguishing between the two lesion types was determined using ROC analysis. All lesions that were classified as "undetermined" after CEUS were reclassified using the elasticity values.
  
  
  RESULTS
  The mean elasticity value was 46.99 ± 31.15 kPa for FNHs and 12.08 ± 10.68 kPa for HAs (p<0.0001). The mean relative elasticity ratio values were 7.94 ± 6.43 and 1.91 ± 1.70, respectively (p<0.0001). The ROC analysis showed a maximal accuracy of 95% for identification with a cut-off of 18.8 kPa for lesion elasticity (accuracy of 96% with a cut-off of 1.98 for the relative elasticity ratio). A total of 68 CEUS were performed, and 17 lesions (25%) were classified as "undetermined" after CEUS. With these cut-off values 16 lesions (94.1%) were correctly reclassified as FNHs.
  
  
  CONCLUSIONS
  SWE is a useful adjunctive tool for differentiation between FNH and HA during ultrasound examination.
authors: Service de Radiologie, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: thomasbrunel20@gmail.com.
authors: Thomas
authors: T
authors: Brunel
authors: Service d'imagerie abdominale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon cedex 03, France. Electronic address: aymeric.guibal@gmail.com.
authors: Aymeric
authors: A
authors: Guibal
authors: Service d'imagerie abdominale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon cedex 03, France. Electronic address: camilboul@hotmail.fr.
authors: Camille
authors: C
authors: Boularan
authors: Service de Chirurgie Digestive, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: christian.ducerf@chu-lyon.fr.
authors: Christian
authors: C
authors: Ducerf
authors: Service de Chirurgie Digestive, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: jean-yves.mabrut@chu-lyon.fr.
authors: Jean-Yves
authors: JY
authors: Mabrut
authors: Service d'Anatomie et de Cytologie Pathologiques, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: brigitte.bancel@chu-lyon.fr.
authors: Brigitte
authors: B
authors: Bancel
authors: Service de Radiologie, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: loic.boussel@chu-lyon.fr.
authors: Loïc
authors: L
authors: Boussel
authors: Service de Radiologie, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: agnes.rode@chu-lyon.fr.
authors: Agnès
authors: A
authors: Rode
mesh_terms: D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasound; Focal liver lesion; Focal nodular hyperplasia; Hepatocellular adenoma; Shear wave elastography; Ultrasound