Focal Hypoechoic Tumors of Fatty Liver

Objective. The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast‐enhanced ultrasonography (CEUS). Methods. Sixty‐four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results . Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill‐in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. Conclusions. With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.     

超声造影与增强CT／MRI诊断直径≤3cm肝脏占位病变的对比研究

摘要目的比较分析超声造影与增强CT／MRI在诊断直径≤3cm肝脏占位病变中的价值。方法≤3cm的肝脏占位病灶40例患者分别进行超声造影、增强CT／MRI检查,比较超声造影与增强CT／MRI诊断≤3cm肝占位病变的准确性及两者之间的相关性。结果超声造影与增强CT／MRI诊断≤3cm的肝脏占位病灶的准确性分别为90．0％及82．5％,二者比较差异无统计学意义;但二者之间有较好的相关性（k=0．69）。对于病史不明确的单个占位病灶,超声造影可通过对增强时相的比较分析,鉴别其性质。结论超声造影及增强CT／MRI对≤3cm肝脏占位病变的诊断均有较好的临床实用价值。     

Characterization of focal liver lesions: comparison of pulse-inversion harmonic contrast-enhanced sonography with contrast-enhanced CT

PURPOSE: To compare the efficacy of contrast-enhanced pulse-inversion harmonic sonography for the characterization of focal liver lesions with that of contrast-enhanced helical CT. METHODS: Real-time contrast-enhanced sonography (CEUS) using Sonovue and contrast-enhanced CT (CECT) were performed on 109 patients with focal liver lesions, including 61 hepatocellular carcinomas, 15 liver metastases, 5 cholangiocellular carcinomas, 12 hemangiomas, 5 regenerative nodules, 3 adenomas, 3 focal nodular hyperplasias, 4 focal necroses, and 1 angiomyolipoma prior to surgery or percutaneous needle biopsy. The diagnostic performance was assessed by using histopathological results as reference standards. RESULTS: Three cases were missed on CEUS, and 7 cases were missed on CECT. These 10 missed cases were excluded from paired statistical comparison. Ten cases were misdiagnosed on CEUS and 17 cases were misdiagnosed on CECT. The overall accuracy was 89.9% (89/99) for CEUS and 82.8% (82/99) for CECT. The difference between CEUS and CECT was not statistically significant. Concordance between CEUS and CECT was observed in 90.9% (90/99) cases. CONCLUSION: Real-time pulse-inversion harmonic CEUS with Sonovue is comparable with CECT in the characterization of focal liver lesions.     

Focal liver lesions: sinusoidal phase of CEUS

Ultrasound examination is the first imaging modality for hepatic study in neoplastic and chronic liver diseases. Focal liver lesions frequently cause diagnostic problems in terms of characterization, especially when small and hypoechoic to the rest of the parenchyma. Contrast- enhanced ultrasonography (CEUS) has shown its value in the characterization of focal liver lesions. This study assessed the value of the sinusoidal phase of CEUS with a second-generation contrast agent in the characterization of focal liver lesions to distinguish benign from malignant. Two hundred hepatic lesions with suspicious features at baseline ultrasound were prospectively studied with CEUS. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the sinusoidal phase in the characterization of benign versus malignant liver lesions were evaluated. Hypoechogenicity of the focal liver lesion, during the sinusoidal phase of CEUS, allowed the diagnosis of malignancy with a sensitivity of 85%, specificity of 88%, positive predictive value of 92%, negative predictive value of 77%, and diagnostic accuracy of 86%. The diagnostic confidence in the diagnosis of malignancy significantly increased, with receiver operating characteristic curve areas from 0.536 for baseline ultrasound to 0.902 for the sinusoidal phase of CEUS.     

超声造影对肝脏局灶性病变的诊断价值

目的：探讨超声造影对肝脏局灶性病变的诊断价值。方法：采用低机械指数实时连续成像技术和造影剂SonoVue对149例肝脏局灶性病变作超声造影检查。结果：149确肝脏局灶性病变中，肝脏恶性肿瘤具有较特征性的超声造影表现，而良性病变除血管瘤、局灶性增生结节、肝脏囊性占位具有特征性的改变易于诊断外，其他尚无特征性表现。结论：超声造影对肝脏局灶性病变具有较高的诊断价值，尤其是鉴别良恶性病变。     

Malignant focal liver lesions at contrast-enhanced ultrasonography and magnetic resonance with hepatospecific contrast agent

The aim of this study was to compare the diagnostic accuracy of the late phase of CEUS and the hepatobiliary phase of CE-MR with Gd-BOPTA in the characterization of focal liver lesions in terms of benignity and malignancy. A total of 147 solid focal liver lesions (38 focal nodular hyperplasias, 1 area of focal steatosis, 3 regenerative nodules, 8 adenomas, 11 cholangiocarcinomas, 36 hepatocellular carcinomas and 49 metastases) were retrospectively evaluated in a multicentre study, both with CEUS, using sulphur hexafluoride microbubbles (SonoVue, Bracco, Milan, Italy) and CE-MR, performed with Gd-BOPTA (Multihance, Bracco, Milan, Italy). All lesions thought to be malignant were cytohistologically proven, while all lesions thought to be benign were followed up. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy were calculated for the late phase of CEUS and the hepatobiliary phase of CE-MRI, respectively, and in combination. Analysis of data revealed 42 benign and 105 malignant focal liver lesions. We postulated that all hypoechoic/hypointense lesions on the two phases were malignant. The diagnostic errors were 13/147 (8.8%) by CEUS and 12/147 (8.2%) by CE-MR. Sensitivity, specificity, PPV, NPV and accuracy of the late phase of CEUS were 90%, 93%, 97%, 80% and 91%, 93%, 97%, 81% and 92% for the hepatobiliary phase of CE-MRI, respectively. If we considered both techniques, the misdiagnosis diminished to 3/147 (2%) and sensitivity, specificity, PPV, NPV and accuracy were 98%, 98%, 99%, 95% and 98%. The combination of the late phase of CEUS and the hepatobiliary phase of CE-MR in the characterization of solid focal liver lesions in terms of benignity and malignancy is more accurate than the two techniques used separately.     

肝肿瘤实时灰阶谐波超声造影与动态增强螺旋CT对照研究

目的 探讨实时灰阶谐波超声造影和动态增强螺旋CT对肝局灶性病变的诊断价值.方法 选择肝局灶性病变患者49例,共54个病灶.其中包括原发性肝癌29个,转移性肝癌4个,肝血管瘤11个,肝局灶性结节增生7个,肝硬化结节1个,肝脂肪浸润不均2个.分别进行实时灰阶谐波超声造影和动态增强螺旋CT检查,比较肝肿瘤在两种成像方法中的表现.结果 两种成像方法显示的肝肿瘤在不同时相的表现及在动脉相的增强类型相一致.超声造影鉴别诊断肝良恶性病变的敏感性、特异性和准确性分别为 90.9%（30/33）、90.5%（19/21）和 90.7%（49/54）;动态增强螺旋CT鉴别诊断肝良恶性病变的敏感性、特异性、准确性分别为 90.9%（30/33）、95.2%（20/21）和 92.6%（50/54）,二者鉴别肝局灶性病变良恶性的能力差异无显著性意义.结论 实时灰阶谐波超声造影和动态增强螺旋CT均能反映肝病变的血流动力学特性,均有助于肝肿瘤的鉴别诊断.     

超声造影诊断肝脏多发性病灶

目的 探讨超声造影(CEUS)在肝脏多发性病灶中的应用价值.方法 对43例肝脏多发性病灶患者(共86个病灶)行CEUS检查,观察其造影增强模式.所有病灶均经病理或增强CT/MRI证实.结果 43例患者中恶性22例,良性21例.恶性患者中,同一患者的2个病灶增强模式不同者10例(10/22,45.45%);良性患者中,同一患者的2个病灶增强模式不同者3例(3/21,14.29%),两组间差异有统计学意义(P<0.05).结论 在肝脏多发性病灶患者中,恶性患者各病灶CEUS增强模式差异较大,而良性患者各病灶的增强模式基本相同.     

超声造影误诊肝脏局灶性病变原因分析

目的 探讨肝脏局灶性病变的不典型CEUS特征及其误诊原因。 方法 回顾性分析与手术或穿刺病理结果不符的21例肝脏局灶性病变的CEUS特征,分析其误诊原因。 结果 21例CEUS检查误诊患者中,9例病理诊断为恶性病灶,其中8例为肝细胞癌(HCC),1例为肝转移癌,CEUS均误诊为良性病灶;12例病理诊断为良性病灶,其中3例为结节性肝硬化伴脓肿或坏死,3例为肉芽肿伴坏死,3例为血管瘤,1例为局灶性结节增生(FNH),1例为炎性假瘤,1例为血管平滑肌脂肪瘤,CEUS将其中10例误诊为恶性病灶,2例误诊为不同病种间良性病灶。 结论 提高对少见病的认识,加深对各类相关分子学科知识的理解,仔细观察回放动态图像,综合分析造影过程各时相的特点,结合常规超声及临床检查结果,必要时行穿刺活检,可提高CEUS诊断的准确性。     

Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in the diagnosis of solid renal tumors. METHODS: Twenty-nine patients with solid tumors detected on gray scale ultrasonography underwent resection for suspected renal malignancy. Findings of arterial phase contrast computed tomography (CT) and CEUS were compared for each diagnosis. RESULTS: Histopathologic examination of resected lesions showed malignancy in 26 patients (clear cell carcinoma, n = 18; papillary renal cell carcinoma, n = 6; collecting duct carcinoma, n = 1; and infiltrative urothelial carcinoma, n = 1) and benign tumors in 3 patients (oncocytoma, n = 2; and angiomyolipoma, n = 1). Contrast CT failed to show tumor blood flow in 5 of 29 patients, whereas CEUS showed this in all patients. Positive predictive values of CEUS and contrast CT in the diagnosis of renal malignancy were 100% and 82.8%, respectively. Among clear cell carcinomas, hypervascularity was observed on contrast CT in 16 of 18 patients and on CEUS in 17 of 18 patients. On the basis of hypervascularity, diagnostic sensitivity values for clear cell carcinoma were 94.4% for CEUS and 88.9% for contrast CT, whereas specificity values were 45.5% for CEUS and 72.7% for contrast CT. Among papillary cell carcinomas, contrast CT showed avascular lesions in 4 of 6 patients. However, CEUS showed blood flow in these lesions, leading to diagnosis of hypovascular renal tumors. CONCLUSIONS: Contrast-enhanced ultrasonography was more sensitive for detecting slight tumor blood flow than contrast CT and was useful in preoperatively diagnosing malignant hypovascular renal tumors but was less so for hypervascular renal tumors.     

超声造影对脂肪肝内低回声病变定性诊断的应用价值

目的 研究超声造影对脂肪肝内低回声病变的定性诊断价值.方法 143个脂肪肝内低回声病变进行常规超声与超声造影检查.结果 脂肪肝内低回声病变良恶性鉴别诊断常规超声曲线下面积0.800±0.050,超声造影曲线下面积1.000±0.000,2种方法差别有统计学意义(P<0.005).常规超声鉴别恶性的敏感性、特异性、准确性分别为48%、78%、72.7%;超声造影鉴别恶性的敏感性、特异性、准确性分别为100%、99.2%、99.3%.结论 超声造影显著提高了脂肪肝内低回声病变的定性诊断效能.     

CEUS鉴别诊断颈部不同大小淋巴结的良恶性

目的 观察CEUS对颈部不同大小良恶性淋巴结的鉴别诊断价值。方法 将经病理证实的142枚颈部增大淋巴结（良性68枚,恶性74枚）按最大径分为<1 cm、1~2 cm和>2 cm组,行常规超声及CEUS检查,观察其常规超声特征及造影灌注模式,并与病理对照。结果 良性淋巴结55.88%（38/68）表现为均匀高增强型,26.47%（18/68）表现为有规则无灌注区的不均匀增强型或环状增强型;恶性淋巴结中72.97%（54/74）表现为有不规则灌注缺损区的不均匀增强型,14.86%（11/74）为微弱增强型。常规超声鉴别诊断<1 cm、1~2 cm和>2 cm 3组淋巴结良恶性的准确率分别为62.16%（23/37）、69.49%（41/59）和78.26%（36/46）,CEUS诊断的准确率分别为81.08%（30/37）、86.44%（51/59）和86.96%（40/46）;相比常规超声,CEUS能够显著提高对最大径1~2 cm良恶性淋巴结的诊断准确率（P=0.02）。结论 CEUS对鉴别诊断良恶性淋巴结具有一定价值,尤其对最大径1~2 cm淋巴结。     

Solid focal liver lesions indeterminate by contrast-enhanced CT or MR imaging: the added diagnostic value of contrast-enhanced ultrasound

The main clinically recognized application of contrast-enhanced US (CEUS) with microbubble contrast agents is the characterization of incidental focal liver lesions. CEUS with low transmit power insonation allows the real-time assessment of contrast enhancement in a focal liver lesion after microbubble contrast agent injection, during the arterial (10-25 s), portal venous (from 35 s up to 2 min) and late phase (4-6 min after microbubble injection). During the portal venous and late phase benign lesions appear hyper or iso-enhancing in comparison to the adjacent liver parenchyma, while malignant lesions prevalently present contrast washout with hypo-enhancing appearance. CEUS may provide an added diagnostic value in those incidental focal liver lesions in which contrast-enhanced CT or MR imaging are not conclusive. In particular, CEUS may provide an added diagnostic value in those focal liver lesions appearing indeterminate on single-phase CT scan, or on CT scans performed by an incorrect delay time or also after injection of a low dose of iodinated contrast agent, or also in those focal liver lesions revealing equivocal enhancement patterns on contrast-enhanced CT or MR imaging. CEUS may have an added diagnostic value also in hepatocellular nodules in a cirrhotic liver and can be considered a complementary imaging technique to CT.     

超声造影对肝硬化合并肝内局灶性小病灶的诊断价值

目的 探讨超声造影对肝硬化合并肝内局灶性小病灶（≤3.0 cm）的诊断价值.方法 回顾性分析76例合并87个肝内局灶性小病灶（≤3.0 cm）肝硬化患者的常规超声和超声造影检查资料.将肝内局灶性小病灶分为5类：①确定良性;②可能良性;③不确定良恶性;④可能恶性;⑤确定恶性.将常规超声和超声造影结果与病理学结果进行对照分析,计算常规超声和超声造影的敏感性、特异性及准确性.结果 病理诊断恶性病灶41个,良性病灶46个.超声造影和常规超声对肝硬化合并肝内局灶性小病灶的敏感性、特异性及准确性分别为97.8 %、97.6%、97.7%和47.8%、78.0%、62.1%.结论 超声造影技术对鉴别肝硬化合并肝内局灶性小病灶（≤3.0 cm）较常规超声具有更好的临床应用价值     

肝脏病灶大小及肝细胞癌分化程度对超声造影肝脏影像报告与数据管理系统分类诊断的影响北大核心CSCD

目的分析肝脏病灶大小和肝细胞癌(HCC)分化程度对超声造影肝脏影像报告与数据管理系统(CEUS LI-RADS)分类诊断的影响。方法回顾性分析698例接受超声造影(CEUS)的肝脏局灶性病变(FLL)患者,根据肝脏病灶最大径(T)分为T<3 cm、3 cm≤T<5 cm和T≥5 cm组;根据HCC分化程度将其分为高、中及低分化组。观察不同大小肝脏病灶、不同分化程度HCC间CEUS LI-RADS分类的差异;以病理诊断为金标准,计算CEUS LI-RADS分类诊断不同大小HCC(以LR-5类为HCC)的效能。结果698例中,恶性682例,包括599例HCC及83例其他恶性病变,良性病变16例;其中T<3 cm 182例,3 cm≤T<5 cm 208例,T≥5 cm组308例;HCC中,高分化组32例,中分化组346例,低分化组221例。T<3 cm、3 cm≤T<5 cm和T≥5 cm病灶中,根据最终病理诊断,LR-1类均为良性病变,LR-4类中HCC占比依次为85.71%(18/21)、100%(10/10)及100%(2/2);HCC在LR-5类中的占比依次为98.37%(121/123)、95.36%(144/151)及94.50%(206/218),在LR-M类中的占比依次为54.55%(18/33)、39.13%(18/46)及69.77%(60/86)。高、中、低分化HCC组中,LR-5类占比分别为78.13%(25/32)、81.79%(283/346)和73.76%(163/221);LR-M类在低分化HCC组中的占比高于高、中分化组(P均<0.05)。以LR-5类为标准诊断HCC,CEUS LI-RADS针对T<3 cm、3 cm≤T<5 cm和T≥5 cm病灶分类诊断HCC的敏感度分别为76.10%(121/159)、83.72%(144/172)和76.87%(206/268),特异度分别为91.30%(21/23)、80.56%(29/36)和70.00%(28/40)。结论肝脏病灶大小及HCC分化程度均对CEUS LI-RADS分类诊断具有一定影响。     

超声造影与彩色多普勒超声对肝实质性肿块诊断价值

目的比较彩色多普勒超声和实时超声造影在肝实质性肿块中的诊断价值。方法应用彩色多普勒超声及超声造影技术对常规二维超声难以定性的29例患者共33个肝实质性肿块进行检查,结果与手术及病理结果相对照。结果33个肿块中原发性肝细胞性肝癌24个,肝血管瘤3个,肝脏局灶性结节增生3个,局限性脂肪肝2个,肝孤立性坏死结节1个。彩色多普勒超声在肿块内部或肿块周边能检测到动脉血流频谱者共19例21个肿块;超声造影除一例肝孤立性坏死结节外,其余32个病灶均在不同时相出现不同程度强化现象。如以动脉相呈高回声而门脉相及延迟相呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确性为92%;如以肿块内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多普勒超声诊断肝癌的准确性为75%,二者差别有显著性(P<0.05)。结论实时超声造影显著提高肝实质性肿块诊断的准确性,对肝脏实质性肿块良、恶性的诊断及鉴别诊断具有重要价值。     

肝局灶性病变超声造影与增强CT和MRI表现的比较

目的 比较肝局灶性病变CEUS与增强CT(CECT)、增强MRI(CEMRI)表现的异同,并分析差异原因。方法 回顾性分析我院70例肝局灶性病变患者的影像资料,共75个病灶,包括肝细胞癌39个,转移性肝癌6个,胆管细胞癌6个,局灶性结节性增生6个,肝硬化结节5个,肝血管瘤4个,坏死结节4个,其他5个。阅片医师对各时相增强水平、增强类型、有无新发病灶等进行评价。采用Kappa检验评估CEUS与CECT/CEMRI表现及医师阅片结果间的一致性,并分析不一致的影像表现。结果 CEUS与CECT/CEMRI在病灶是否存在确切无增强的坏死或瘢痕区域方面一致性最高(Kappa=0.68);在门静脉期病灶相对于周围肝实质的主要增强水平方面一致性最低(Kappa=0.48)。44.23%(23/52)的恶性病灶及21.74%(5/23)良性病灶的CEUS与CECT/CEMRI表现不完全一致。结论 CEUS与CECT/CEMRI各时相表现一致性较好,差异性表现多集中于恶性病变。病灶影像表现存在差异的原因可能与对比剂不同及病理组织特征等有关。     

超声造影对少罕见局灶性肝病变的诊断价值

目的探讨超声造影对少罕见局灶性肝病变（FLL）的诊断价值及“快进快出”造影模式对少罕见FLL超声造影的诊断价值。 方法回顾分析2012年1月至2019年8月在华中科技大学同济医学院附属同济医院就诊的FLL患者的超声造影资料，人群发病率＜0.05%的病变纳入本研究少罕见FLL组，共纳入61个少罕见FLL病灶，其中33个病灶经MRI/CT检查。以病理结果为金标准，采用四格表评价超声造影、MRI/CT检查以及两者联合对少罕见FLL良恶性的诊断效能，并采用χ²检验比较不同检查方式之间诊断准确性的差异。 结果61个少罕见FLL中，超声造影正确诊断病灶良恶性的敏感度为51.9%（28/54）、特异度为85.7%（6/7）、阳性预测值为96.6%（28/29）、阴性预测值为18.8%（6/32）、诊断准确性为55.7%（34/61）。33个同期行MRI/CT检查的少罕见FLL，超声造影良恶性诊断的诊断准确性略高于MRI/CT检查（48.5% vs 39.4%），但差异无统计学意义（P＞0.05）。超声造影+MRI/CT联合对少罕见FLL良恶性诊断的准确性（69.7%）高于单独MRI/CT检查或超声造影，差异均具有统计学意义（χ²=6.111，P=0.013；χ²=3.070，P=0.046）。对于呈现“快进快出”造影模式的少罕见FLL，超声造影诊断符合率为18.8%（6/32）。实际工作中，超声医师结合临床表现与实验室检查后超声诊断原始报告的诊断符合率为56.3%（18/32），高于单独超声造影诊断，差异具有统计学意义（χ²=9.600，P=0.002）。 结论超声造影对少罕见FLL具有一定诊断价值，与MRI/CT联合应用可提高诊断准确性。对于“快进快出”造影模式的少罕见FLL的诊断，结合临床表现与实验室检查有助于提高诊断符合率。     

超声造影与增强螺旋CT诊断肝硬化背景下≤2 cm结节样病灶的比较研究

目的 探讨超声造影(contrast-enhanced ultrasound,CEUS)与增强螺旋CT(contrast-enhanced helical computed tomography,CECT)对肝硬化背景下≤2 cm结节样病灶的诊断效能.方法 对72例81个肝硬化背景下常规超声检查可疑肝内小占化病变者(最大直径≤2 cm)进行CEUS和CECT检查(两者间隔时间≤2周),将两种检查的术前诊断与病理结果进行比较分析,评估两种检查方法的诊断效能.结果 81个病灶53个为肝细胞癌(HCC),26个增生结节,2个血管瘤.53个HCC中,CEUS 51个(96.2%)病灶动脉期呈高增强,CECT 41个(77.4%)病灶动脉期显示强化,CEUS与CECT在显示动脉期血供方面差异有统计学意义(P<0.01).以病灶动脉期呈高增强,门脉期或延迟期消退为低增强作为诊断HCC的标准,CEUS诊断小结节样病灶的敏感性、特异性、准确性分别为86.8%、82.1%、85.2%.CECT分别为73.6%、92.9%、80.2%(P>0.05).结论 CEUS对≤2 cm HCC动脉期血供的显示率高于CECT,CEUS对肝硬化背景下小结节样病灶的诊断能力与CECTT相似.     

Acoustic Radiation Force Impulse Elastography for the Evaluation of Focal Solid Hepatic Lesions: Preliminary Findings

This study was designed to investigate the potential usefulness of acoustic radiation force impulse (ARFI) elastography to evaluate focal solid hepatic lesions. In total, 51 patients with 60 focal hepatic lesions, which included 17 hemangiomas, 25 hepatocellular carcinomas (HCCs), 15 metastases and three cholangiocarcinomas, underwent ARFI elastography. The lesions were classified into three groups: Group I consisted of metastatic liver tumors and cholangiocarcinomas, group II consisted of HCCs and group III consisted of hemangiomas. The stiffness and conspicuity of the tumors as depicted on ARFI elastography and the echogenicity and conspicuity of the tumors on corresponding B-mode images were analyzed. Shear wave velocity was obtained to quantify stiffness for 36 focal hepatic lesions: 11 hemangiomas, 17 HCCs and eight other malignant lesions.