Assessment of intraoperative quantitative shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions (FLLs) during liver surgery using postoperative histopathological results as the gold standard.


 Multifrequency linear/T-shaped probes (6 - 9 MHz) were used to store cine loops of at least 5 s and images of B-mode, SWE and CEUS.  The first CEUS loop was continuously documented over 1 min. in each case.  CEUS was evaluated during the arterial, portal venous and late phase after i.  Postoperative histopathology after tumor resection or intraoperative biopsy was obtained to confirm findings of SWE and CEUS.


 CEUS could correctly identify 86/88 malignant and 8/10 benign FLLs.  SWE could correctly identify 2 malignant FLLs which CEUS falsely characterized as benign.


 Intraoperative CEUS and SWE are excellent tools for the highly accurate visualization, characterization and malignancy assessment of hepatic tumors during liver surgery.
CEUS
Assessment of intraoperative quantitative shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions (FLLs) during liver surgery using postoperative histopathological results as the gold standard.


 Multifrequency linear/T-shaped probes (6 - 9 MHz) were used to store cine loops of at least 5 s and images of B-mode, SWE and CEUS.  Quantitative SWE analysis of FLLs was performed by placing 5 regions of interest to measure shear wave speed (m/s) and stiffness (kPa).  Postoperative histopathology after tumor resection or intraoperative biopsy was obtained to confirm findings of SWE and CEUS.


 SWE characterized 73/88 FLLs correctly as malignant and 7/10 as benign using a cut-off value of 2.5 m/s/21.3 kPa (p < 0.0005).  SWE could correctly identify 2 malignant FLLs which CEUS falsely characterized as benign.


 Intraoperative CEUS and SWE are excellent tools for the highly accurate visualization, characterization and malignancy assessment of hepatic tumors during liver surgery.
SWE