Role of compression sonoelastography in aiding differentiation of benign and malignant solid hepatic lesions

Background: The liver is primarily or secondarily involved by numerous vascular, metabolic, infectious, and neoplastic processes resulting in formation of focal liver masses, and the detection of such focal liver lesions is frequently accomplished with sonography. However, the categorization a liver mass as benign or malignant on ultrasound has always been a diagnostic dilemma. Objective: This study aimed to assess if the addition of compression sonoelastography to conventional B-mode ultrasound aided in diagnostic accuracy of the focal hepatic lesions. Materials and Methods: We evaluated B-mode characteristics of 52 liver lesions followed by calculation of their strain values on compression sonoelastography. The lesions were categorized as benign or malignant by ascertaining a cutoff strain value and the comparison was made with the histopathological diagnosis/contrast-enhanced computed tomography characteristics of the lesions. Results: The mean strain index value of malignant hepatic lesions (2.12 ± 1.06) was statistically higher than the benign lesions (0.92 ± 1.06) with 2-tailed P = 0.002. The sensitivity, specificity, and positive and negative predictive values of compression sonoelastography in diagnosing a malignant pathology were 74.4%, 88.9%, 94.6%, and 46.7%, respectively, and the additional evaluation of B-mode features yielded higher sensitivity (95.4% vs. 83.7%) and negative predictive value (75% vs. 46.7%). Conclusion: Compression sonoelastography is an efficient and beneficial complementary tool to B-mode imaging in evaluating solid liver lesions.