Grgurevic I Bokun T Salkic NN Brkljacic B Vukelić-Markovic M Stoos-Veic T Aralica G Rakic M Filipec-Kanizaj T Berzigotti A 2018 BACKGROUND & AIMS To analyse elastographic characteristics of focal liver lesions (FLL)s and diagnostic performance of real-time two-dimensional shear-wave elastography (RT-2D-SWE) in order to differentiate benign and malignant FLLs. METHODS Consecutive patients diagnosed with FLL by abdominal ultrasound (US) underwent RT-2D-SWE of FLL and non-infiltrated liver by intercostal approach over the right liver lobe. The nature of FLL was determined by diagnostic work-up, including at least one contrast-enhanced imaging modality (MDCT/MRI), check-up of target organs when metastatic disease was suspected and FLL biopsy in inconclusive cases. RESULTS We analysed 196 patients (median age 60 [range 50-68], 50.5% males) with 259 FLLs (57 hepatocellular carcinomas, 17 cholangiocarcinomas, 94 metastases, 71 haemangiomas, 20 focal nodular hyperplasia) of which 70 (27%) were in cirrhotic liver. Malignant lesions were stiffer (P < .001) with higher variability in intralesional stiffness (P = .001). The best performing cut-off of lesion stiffness was 22.3 kPa (sensitivity 83%; specificity 86%; positive predictive value [PPV] 91.5%; negative predictive value [NPV] 73%) for malignancy. Lesion stiffness <14 kPa had NPV of 96%, while values >32.5 kPa had PPV of 96% for malignancy. Lesion stiffness, lesion/liver stiffness ratio and lesion stiffness variability significantly predicted malignancy in stepwise logistic regression (P < .05), and were used to construct a new Liver Elastography Malignancy Prediction (LEMP) score with accuracy of 96.1% in validation cohort (online calculator available at http://bit.do/lemps). CONCLUSION The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE. https://sonar.ch/global/documents/49111 eng info:eu-repo/semantics/altIdentifier/doi/10.1111/liv.13611 info:eu-repo/semantics/altIdentifier/pmid/29028279 Liver international : official journal of the International Association for the Study of the Liver. - 2018 liver tumors non-invasive diagnosis shear wave elastography ultrasound Aged Carcinoma, Hepatocellular Cholangiocarcinoma Elasticity Imaging Techniques Female Focal Nodular Hyperplasia Hemangioma Humans Liver Liver Neoplasms Logistic Models Male Middle Aged Reproducibility of Results Sensitivity and Specificity Severity of Illness Index Tomography, X-Ray Computed Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions. http://purl.org/coar/resource_type/c_6501