Quantitative Assessment of Peritumoral Stiffness Using Shell Elastography Enhances the Differentiation of Hepatocellular Carcinoma From Metastatic Liver Carcinoma

Objectives To evaluate the discriminatory potential of peritumoral tissue stiffness, as quantified by 2‐dimensional shear wave elastography, for distinguishing between hepatocellular carcinoma (HCC) and metastatic liver carcinoma (MLC). Methods This study enrolled 31 patients with HCC and 42 with MLC. The mean Young's modulus (E) value was measured to evaluate the intratumoral and peritumoral stiffness of HCC and MLC by using the 2‐dimensional shear wave elastography integrated with the shell measurement function. The intratumoral stiffness and the peritumoral stiffness within the 1‐, 2‐, and 3‐mm shells surrounding the target lesion were labeled as E, E shell1 , E shell2 , and E shell3 , respectively. The discriminatory capacity of the E and E shell parameters to distinguish HCC from MLC was assessed by generating receiver operating characteristic curves. Results The E shell1 , E shell2 , and E shell3 values in patients with HCC were higher than those with MLC, whereas the E values in patients with HCC were lower than those with MLC ( p < .05). In addition, the E shell1 , E shell2 , E shell3 , and E values showed good diagnostic performance in differentiating HCC from MLC. Among them, E shell1 had better diagnostic performance, with a specificity, sensitivity, positive predictive value, and negative predictive value of 64, 88, 59, and 90%, respectively (cut‐off value, 19.84 kPa; area under the receiver operating characteristic curve, 0.763). Conclusions Quantitative assessment of peritumoral stiffness, particularly within a precisely defined 1‐mm shell using advanced shell elastography, significantly enhances the differentiation of HCC from MLC.