Strain elastography versus triphasic computed tomography in differentiating solid neoplastic focal liver lesions: a prospective study

Abstract

Differentiating solid focal liver lesions (FLLs) is crucial for guiding management. Triphasic computed tomography (CT) is widely used, while sonoelastography offers a noninvasive assessment of tissue stiffness and may complement conventional imaging. To evaluate the diagnostic accuracy of strain sonoelastography compared with triphasic CT in differentiating benign and malignant solid FLL. A prospective study was performed on 50 patients with solid FLL, confirmed by histopathology and/or standard imaging criteria. Patients were divided into benign ( n =13) and malignant ( n =37) groups. All underwent strain sonoelastography, with strain ratio measurement, and triphasic CT. Diagnostic performance indices were calculated and compared. Malignant lesions demonstrated significantly higher stiffness values than benign lesions. Using a cut-off strain ratio of more than or equal to 2.6, sonoelastography yielded sensitivity of 89.2%, specificity of 92.3%, positive predictive value of 97.1%, negative predictive value of 75.0%, and overall accuracy of 90%. Triphasic CT showed slightly higher diagnostic performance, with sensitivity of 91.8%, specificity of 92.3%, positive predictive value of 97.1%, negative predictive value of 80.0%, and accuracy of 92%. Both techniques demonstrated excellent agreement with final diagnosis. Strain elastography provides reliable differentiation between benign and malignant FLLs, with accuracy approaching triphasic CT. Its use alongside ultrasound offers a valuable, noninvasive adjunct, particularly when ultrasound findings are indeterminate or CT is contraindicated.