Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2020; 26(46): 7416-7424
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7416
Value of shear wave elastography with maximal elasticity in differentiating benign and malignant solid focal liver lesions
Hui-Ping Zhang, Ji-Ying Gu, Min Bai, Fan Li, Yu-Qing Zhou, Lian-Fang Du
Hui-Ping Zhang, Yu-Qing Zhou, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200050, China
Ji-Ying Gu, Department of Ultrasound, Shanghai Fourth People’s Hospital, Shanghai Tongji University School of Medicine, Shanghai 200434, China
Min Bai, Fan Li, Lian-Fang Du, Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
Author contributions: Zhang HP designed the study, drafted the manuscript, and assisted with the data analysis; Gu JY performed ultrasound elastography examinations; Bai M performed conventional ultrasound examinations; Li F collected data and assisted with the data analysis; Zhou YQ drafted the manuscript and performed statistical analysis; Du LF designed the study and drafted the manuscript; All authors read and approved the final manuscript.
Supported by Natural Science Foundation of Shanghai of China, No. 19ZR1441500.
Institutional review board statement: The study was approved by the Ethics Committee of Shanghai First People’s Hospital.
Clinical trial registration statement: This study is registered at clinical hospital center “Shanghai General Hospital, Shanghai Jiaotong University School of Medicine” trial registry. Registration identification, No. ChiCTR1800016590.
Informed consent statement: Written informed consent was obtained from every patient.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lian-Fang Du, MD, Chief Doctor, Full Professor, Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 100 Haining Road, Shanghai 200080, China.
Received: September 18, 2020
Peer-review started: September 18, 2020
First decision: October 17, 2020
Revised: October 30, 2020
Accepted: November 13, 2020
Article in press: November 13, 2020
Published online: December 14, 2020

It is important to differentiate benign and malignant focal liver lesions (FLLs) accurately. Despite the wide use and acceptance of shear wave elastography (SWE), its value for assessing the elasticity of FLLs and differentiating benign and malignant FLLs is still investigational. Previous studies of SWE for FLLs used mean elasticity as the parameter to reflect the stiffness of FLLs. Considering the inhomogeneity of tumor stiffness, maximal elasticity (Emax) might be the suitable parameter to reflect the stiffness of FLLs and to differentiate malignant FLLs from benign ones.


To explore the value of SWE with Emax in differential diagnosis of solid FLLs.


We included 104 solid FLLs in 95 patients and 50 healthy volunteers. All the subjects were examined using conventional ultrasound (US) and virtual touch tissue quantification(VTQ) imaging. A diagnosis of benign or malignant FLL was made using conventional US. Ten VTQ values were acquired after 10 consecutive measurements for each FLL and each normal liver, and the largest value was recorded as Emax.


There were 56 cases of malignant FLLs and 48 cases of benign FLLs in this study. Emax of malignant FLLs (3.29 ± 0.88 m/s) was significantly higher than that of benign FLLs (1.30 ± 0.46 m/s, P < 0.01) and that of livers in healthy volunteers (1.15 ± 0.17 m/s, P < 0.01). The cut-off point of Emax was 1.945, and the area under the curve was 0.978. The sensitivity and specificity of Emax were 92.9% and 91.7%, respectively, higher (but not significantly) than those of conventional US (80.4% for sensitivity and 81.3% for specificity). Combined diagnosis of conventional US and Emax using parallel testing improved the sensitivity to 100% with specificity of 75%.


SWE is a convenient and easy method to obtain accurate stiffness information of solid FLLs. Emax is useful for differential diagnosis of FLLs, especially in combination with conventional US.

Keywords: Focal hepatic lesions, Shear wave elastography, Conventional ultrasound, Maximal elasticity

Core Tip: Shear wave elastography (SWE) has been used with promising results in the assessment of liver fibrosis and in the differential diagnosis of thyroid and breast nodules. However, its value for the differential diagnosis between malignant and benign focal liver lesions (FLLs) is still investigational. In this study, instead of the common parameter (mean elasticity), we used maximal elasticity (Emax) as the parameter to explore the value of SWE in the differential diagnosis of FLLs. Our results showed that Emax is useful for differential diagnosis of FLLs, especially in combination with conventional ultrasound.