Wey Chyi Teoh MBBS, FRCR, Presenter: Nothing to Disclose

Mark Joshua Abel MBBS, Abstract Co-Author: Nothing to Disclose

Christina Kalli MENG, Abstract Co-Author: Nothing to Disclose

Behzad Mokri-Moayyed, Abstract Co-Author: Nothing to Disclose

Matthew F. Bruce PhD, Abstract Co-Author: Employee, SuperSonic Imagine

Harpreet Wasan MD, PhD, Abstract Co-Author: Nothing to Disclose

Edward Leen MD, FRCR, Abstract Co-Author: Equipment support, Koninklijke Philips NV Equipment support, General Electric Company Equipment support, SuperSonic Imagine Research Consultant, General Electric Company Speakers Bureau, Bracco Group Speakers Bureau, Koninklijke Philips NV Speakers Bureau, AngioDynamics, Inc Speakers Bureau, General Electric Company

To evaluate SWE in monitoring treatment response of patients with hepatic tumours.

Forty-five patients undergoing non-surgical treatment for focal hepatic malignancies were studied using an ultrasound scanner with a curvilinear SC6-1 transducer (Aixplorer, Supersonic Imagine, France) after 4 hours of fasting. The scans were performed at baseline, 2 weeks and 8 weeks post therapy under respiratory suspension. Three SWE scan planes of tumour and liver were acquired, analysed and averaged following placement of fixed regions of interest (10mm3) over the peripheral and central portion of the index tumours and adjacent hepatic parenchyma. Based on RECIST criteria, patients were classified as progressors (Pr) or non-progressors (NPr) at 8 weeks post therapy. SWE readings from baseline, 2 and 8 weeks (Wilcoxon test) and between Pr and NPr (Mann-Whitney test) were compared. Area under receiver operating characteristics (AUROC) and Kaplan-Meier survival curves were plotted. The mean follow up was 233 days.    

At baseline, liver SWE was significantly higher for Pr compared with NPr (13.4 ± 3.8kPa vs. 9.7 ±3.9kPa, p=0.01); a cut off value of ≤8.35kPa predicted non-progression following treatment [AUROC:0.77 (p=0.01), specificity:90.1%, sensitivity:58.3%, positive predictive value:93.3% & likelihood ratio of 6.4]. Compared with baseline, 2-week tumour SWE was significantly increased for both Pr (41.8 ± 10.6kPa vs. 50.7 ± 18.3, p=0.047) and NPr (51.2 ± 20.2kPa vs. 60.7 ± 22.0kPa, p=0.001). Compared with baseline, 8-week tumour SWE was significantly increased for both Pr (41.8 ± 10.6kPa vs. 61.9 ± 18.3kPa, p=0.02) and NPr (51.2 ± 20.2kPa vs. 74.3 ± 26.1kPa, p=0.002). At baseline, patients with liver SWE of ≥15kPa have a significantly shorter progression free survival (PFS) (Median 89 days vs 294 days, p=0.01). Compared with baseline, patients with an increase at 8-week liver SWE (of ≥40%) have a significantly shorter PFS (Median 85 days vs. 294 days, p=0.049).  

Liver SWE at baseline predicts non-progressors following therapy. Patients with a baseline liver SWE of ≥15kPa or an increase of ≥40% at 8 weeks from baseline have shorter PFS. Tumour SWE is non prognostic.

SWE is useful in predicting non-progressors and progression free survival following non-surgical therapy for hepatic malignancy.

Teoh, W, Abel, M, Kalli, C, Mokri-Moayyed, B, Bruce, M, Wasan, H, Leen, E, Ultrasound Shearwave Elastography (SWE) Predicts Response in the Treatment of Patients with Liver Malignancies.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000675.html