Abstract：
OBJECTIVE: To establish shear-wave elastography (SWE) combined with contrast-enhanced ultrasound (CEUS) algorithm (SCCA) and improve the diagnostic performance in differentiating focal liver lesions (FLLs).
METHODS: We retrospectively selected patients with FLLs between January 2018 and December 2019 at the First Affiliated Hospital of Sun Yat-sen University. Histopathology was used as a standard criterion except for hemangiomas and focal nodular hyperplasia. CEUS with SonoVue (Bracco Imaging) and SCCA combining CEUS and maximum value of elastography with < 20 kPa and > 90 kPa thresholds were used for the diagnosis of FLLs. The diagnostic performance of CEUS and SCCA was calculated and compared.
RESULTS: A total of 171 FLLs were included, with 124 malignant FLLs and 47 benign FLLs. The area under curve (AUC), sensitivity, and specificity in detecting malignant FLLs were 0.83, 91.94%, and 74.47% for CEUS, respectively, and 0.89, 91.94%, and 85.11% for SCCA, respectively. The AUC of SCCA was significantly higher than that of CEUS (P = 0.019). Decision curves indicated that SCCA provided greater clinical benefits. The SCCA provided significantly improved prediction of clinical outcomes, with a net reclassification improvement index of 10.64% (P = 0.018) and integrated discrimination improvement of 0.106 (P = 0.019). For subgroup analysis, we divided the FLLs into a chronic-liver-disease group (n = 88 FLLs) and a normal-liver group (n = 83 FLLs) according to the liver background. In the chronic-liver-disease group, there were no differences between the CEUS-based and SCCA diagnoses. In the normal-liver group, the AUC of SCCA and CEUS in the characterization of FLLs were 0.89 and 0.83, respectively (P = 0.018).
CONCLUSIONS: SCCA is a feasible tool for differentiating FLLs in patients with normal liver backgrounds. Further investigations are necessary to validate the universality of this algorithm.
METHODS: We retrospectively selected patients with FLLs between January 2018 and December 2019 at the First Affiliated Hospital of Sun Yat-sen University. Histopathology was used as a standard criterion except for hemangiomas and focal nodular hyperplasia. CEUS with SonoVue (Bracco Imaging) and SCCA combining CEUS and maximum value of elastography with < 20 kPa and > 90 kPa thresholds were used for the diagnosis of FLLs. The diagnostic performance of CEUS and SCCA was calculated and compared.
RESULTS: A total of 171 FLLs were included, with 124 malignant FLLs and 47 benign FLLs. The area under curve (AUC), sensitivity, and specificity in detecting malignant FLLs were 0.83, 91.94%, and 74.47% for CEUS, respectively, and 0.89, 91.94%, and 85.11% for SCCA, respectively. The AUC of SCCA was significantly higher than that of CEUS (P = 0.019). Decision curves indicated that SCCA provided greater clinical benefits. The SCCA provided significantly improved prediction of clinical outcomes, with a net reclassification improvement index of 10.64% (P = 0.018) and integrated discrimination improvement of 0.106 (P = 0.019). For subgroup analysis, we divided the FLLs into a chronic-liver-disease group (n = 88 FLLs) and a normal-liver group (n = 83 FLLs) according to the liver background. In the chronic-liver-disease group, there were no differences between the CEUS-based and SCCA diagnoses. In the normal-liver group, the AUC of SCCA and CEUS in the characterization of FLLs were 0.89 and 0.83, respectively (P = 0.018).
CONCLUSIONS: SCCA is a feasible tool for differentiating FLLs in patients with normal liver backgrounds. Further investigations are necessary to validate the universality of this algorithm.
摘要：
目的：建立剪切波弹性成像（SWE）结合超声造影（CEUS）算法（SCCA），提高肝脏局灶性病变（FLL）的鉴别诊断能力。
方法：回顾性选择2018年1月至2019年12月在中山大学附属第一医院就诊的FLL患者。除血管瘤和局灶性结节增生外，组织病理学被用作标准标准。超声造影（超声造影）和SCCA结合超声造影和弹性成像最大值（阈值<20kPa和>90kPa）用于FLL的诊断。计算并比较了CEUS和SCCA的诊断性能。
结果：共包括171个FLL，124例恶性FLL和47例良性FLL。曲线下面积（AUC），灵敏度,检测恶性FLL的特异性分别为0.83、91.94%，CEUS为74.47%，分别,和0.89，91.94%，SCCA为85.11%，分别。SCCA的AUC显著高于CEUS(P=0.019)。决策曲线表明SCCA提供了更大的临床益处。SCCA提供了显著改善的临床结果预测，净重新分类改善指数为10.64％（P=0.018），综合判别改善指数为0.106（P=0.019）。对于子组分析，我们根据肝脏背景将FLL分为慢性肝病组(n=88)和正常肝脏组(n=83).在慢性肝病组中，基于CEUS和SCCA的诊断没有差异.在正常肝脏组中，SCCA和CEUS在FLL表征中的AUC分别为0.89和0.83(P=0.018)。
结论：SCCA是区分正常肝脏背景患者FLL的可行工具。需要进一步的研究来验证该算法的普遍性。
方法：回顾性选择2018年1月至2019年12月在中山大学附属第一医院就诊的FLL患者。除血管瘤和局灶性结节增生外，组织病理学被用作标准标准。超声造影（超声造影）和SCCA结合超声造影和弹性成像最大值（阈值<20kPa和>90kPa）用于FLL的诊断。计算并比较了CEUS和SCCA的诊断性能。
结果：共包括171个FLL，124例恶性FLL和47例良性FLL。曲线下面积（AUC），灵敏度,检测恶性FLL的特异性分别为0.83、91.94%，CEUS为74.47%，分别,和0.89，91.94%，SCCA为85.11%，分别。SCCA的AUC显著高于CEUS(P=0.019)。决策曲线表明SCCA提供了更大的临床益处。SCCA提供了显著改善的临床结果预测，净重新分类改善指数为10.64％（P=0.018），综合判别改善指数为0.106（P=0.019）。对于子组分析，我们根据肝脏背景将FLL分为慢性肝病组(n=88)和正常肝脏组(n=83).在慢性肝病组中，基于CEUS和SCCA的诊断没有差异.在正常肝脏组中，SCCA和CEUS在FLL表征中的AUC分别为0.89和0.83(P=0.018)。
结论：SCCA是区分正常肝脏背景患者FLL的可行工具。需要进一步的研究来验证该算法的普遍性。
