Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2016; 22(9): 2647-2656
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2647
Ultrasound elastographic techniques in focal liver lesions
Clara Benedetta Conti, Federica Cavalcoli, Mirella Fraquelli, Dario Conte, Sara Massironi
Clara Benedetta Conti, Federica Cavalcoli, Mirella Fraquelli, Dario Conte, Sara Massironi, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
Clara Benedetta Conti, Federica Cavalcoli, Dario Conte, Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
Author contributions: Massironi S planned the work; Conti CB and Cavalcoli F performed the literature search; Conti CB wrote the first draft of the manuscript; Conti CB, Cavalcoli F and Fraquelli M edited the subsequent versions of the manuscript; Fraquelli M critically revised the manuscript for relevant intellectual content; Conti CB and Fraquelli M corrected the final version; Conti CB and Massironi S wrote the revised version of the manuscript; Finally all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: 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/
Correspondence to: Sara Massironi, MD, PhD, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza, 35, 20122 Milan, Italy. sara.massironi@policlinico.mi.it
Telephone: +39-2-55033445
Received: November 1, 2015
Peer-review started: November 2, 2015
First decision: December 11, 2015
Revised: December 23, 2015
Accepted: January 11, 2016
Article in press: January 11, 2016
Published online: March 7, 2016

Elastographic techniques are new ultrasound-based imaging techniques developed to estimate tissue deformability/stiffness. Several ultrasound elastographic approaches have been developed, such as static elastography, transient elastography and acoustic radiation force imaging methods, which include point shear wave and shear wave imaging elastography. The application of these methods in clinical practice aims at estimating the mechanical tissues properties. One of the main settings for the application of these tools has been liver stiffness assessment in chronic liver disease, which has been studied mainly using transient elastography. Another field of application for these techniques is the assessment of focal lesions, detected by ultrasound in organs such as pancreas, prostate, breast, thyroid, lymph nodes. Considering the frequency and importance of the detection of focal liver lesions through routine ultrasound, some studies have also aimed to assess the role that elestography can play in studying the stiffness of different types of liver lesions, in order to predict their nature and thus offer valuable non-invasive methods for the diagnosis of liver masses.

Keywords: Focal liver lesions, Acoustic radiation force imaging, Transient elastography, Elastographic techniques, Shear wave imaging

Core tip: Elastography is a new ultrasound technique that allows the non-invasive assessment of tissue stiffness. Some elastographic techniques have already been validated and are widely used to evaluate liver stiffness in order to assess hepatic fibrosis and cirrhosis. Elastography is also useful in the diagnosis and characterization of different solid tumors. Considering that only a few studies have so far focused on the role of elastography in the evaluation of focal liver lesions, the present review aims to evaluate the role of real-time sonoelastography, strain elastography and ultrasound-based elastrographic techniques in the differential diagnosis and characterization of focal liver lesions.