Naganuma H, Ishida H, Uno A, Nagai H, Kuroda H, Ogawa M. Diagnostic problems in two-dimensional shear wave elastography of the liver. World J Radiol 2020; 12(5): 76-86 [PMID: 32549956 DOI: 10.4329/wjr.v12.i5.76]
Corresponding Author of This Article
Hiroko Naganuma, MD, PhD, Doctor, Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote 0138602, Akita, Japan. hiron@vesta.ocn.ne.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Hiroko Naganuma, Department of Gastroenterology, Yokote Municipal Hospital, Yokote 0138602, Akita, Japan
Hideaki Ishida, Department of Gastroenterology, Akita Red Cross Hospital, Kamikitatesaruta 0101495, Akita, Japan
Atsushi Uno, Department of Gastroenterology, Oomori Municipal Hospital, Yokote 0130525, Akita, Japan
Hiroshi Nagai, New Generation Imaging Laboratory, Tokyo 1680065, Japan
Hidekatsu Kuroda, Division of Gastroenterology and Hepatology, Iwate Medical University, Morioka 0200023, Iwate, Japan
Masahiro Ogawa, Department of Gastroenterology and Hepatology, Nihon University Hospital, Chiyoda 1018309, Tokyo, Japan
Author contributions: Naganuma H designed the report, collected the patient’s clinical data, and generated the figures; Ishida H designed the report and wrote the paper; Uno A performed the computer simulation; Nagai H generated the figures; Kuroda H and Ogawa M collected the patient’s clinical data.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hiroko Naganuma, MD, PhD, Doctor, Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote 0138602, Akita, Japan. hiron@vesta.ocn.ne.jp
Received: February 25, 2020 Peer-review started: February 25, 2020 First decision: April 7, 2020 Revised: April 19, 2020 Accepted: May 12, 2020 Article in press: May 12, 2020 Published online: May 28, 2020 Processing time: 91 Days and 18.8 Hours
Abstract
Two-dimensional shear wave elastography (2D-SWE) is used in the clinical setting for observation of the liver. Unfortunately, a wide spectrum of artifactual images are frequently encountered in 2D-SWE, the precise mechanisms of which remain incompletely understood. This review was designed to present many of the artifactual images seen in 2D-SWE of the liver and to analyze them by computer simulation models that support clinical observations. Our computer simulations yielded the following suggestions: (1) When performing 2D-SWE in patients with chronic hepatic disease, especially liver cirrhosis, it is recommended to measure shear wave values through the least irregular hepatic surface; (2) The most useful 2D-SWE in patients with focal lesion will detect lesions that are poorly visible on B-mode ultrasound and will differentiate true tumors from pseudo-tumors (e.g., irregular fatty change); and (3) Measurement of shear wave values in the area posterior to a focal lesion must be avoided.
Core tip: Two-dimensional shear wave elastography is the most widely used diagnostic tool for liver but has many ultrasound artifact-related problems. Our computer simulation model suggests the following ways to minimize them: (1) In patients with chronic hepatic disease, especially liver cirrhosis, measure shear wave values through the least irregular hepatic surface; (2) The most useful application in patients with focal lesions is detecting lesions poorly visible on B-mode ultrasound and differentiating true tumors from pseudo-tumors (e.g., irregular fatty change); and (3) Measurement of shear wave values in the area posterior to a focal lesion must be avoided.
