Strain elastography versus triphasic computed tomography in differentiating solid neoplastic focal liver lesions: a prospective study

Background Differentiating solid focal liver lesions (FLLs) is crucial for guiding management. Triphasic computed tomography (CT) is widely used, while sonoelastography offers a noninvasive assessment of tissue stiffness and may complement conventional imaging. Aim To evaluate the diagnostic accuracy of strain sonoelastography compared with triphasic CT in differentiating benign and malignant solid FLL. Patients and methods A prospective study was performed on 50 patients with solid FLL, confirmed by histopathology and/or standard imaging criteria. Patients were divided into benign ( n =13) and malignant ( n =37) groups. All underwent strain sonoelastography, with strain ratio measurement, and triphasic CT. Diagnostic performance indices were calculated and compared. Results Malignant lesions demonstrated significantly higher stiffness values than benign lesions. Using a cut-off strain ratio of more than or equal to 2.6, sonoelastography yielded sensitivity of 89.2%, specificity of 92.3%, positive predictive value of 97.1%, negative predictive value of 75.0%, and overall accuracy of 90%. Triphasic CT showed slightly higher diagnostic performance, with sensitivity of 91.8%, specificity of 92.3%, positive predictive value of 97.1%, negative predictive value of 80.0%, and accuracy of 92%. Both techniques demonstrated excellent agreement with final diagnosis. Conclusions Strain elastography provides reliable differentiation between benign and malignant FLLs, with accuracy approaching triphasic CT. Its use alongside ultrasound offers a valuable, noninvasive adjunct, particularly when ultrasound findings are indeterminate or CT is contraindicated.