| Abstract | Konačna dijagnoza jetrenih tumora postavlja se biopsijom, koja je neugodna metoda i nosi određeni rizik od komplikacija. Iz tog se razloga istražuju neinvazivne metode za karakterizaciju tumora jetre. Jedna od novih metoda je i dvodimenzionalna shear wave elastografija u stvarnom vremenu (RT-2D-SWE). Cilj ovog istraživanja bio je analizirati vrijednosti tvrdoće pojedinih histoloških tipova tumora jetre metodom RT-2D-SWE. U istraživanje je bio uključen 81 pacijent s tumorom jetre, od kojih 31 žena i 50 muškaraca, prosječne dobi 55,2 godine. Svim je bolesnicima ultrazvukom utvrđeno postojanje tumora jetre i pomoću RT-2D-SWE izmjerena tvrdoća tumora, tvrdoća okolnog parenhima te njihov omjer. Vrsta tumora utvrđena je primjenom standardnog dijagnostičkog algoritma koji je uključivao određivanje tumorskih markera (AFP, CEA, CA 19-9, a kod žena i CA 125) i barem jedne radiološke slikovne metode (MSCT i/ili MR) uz primjenu iv kontrasta i skeniranje po višefaznom protokolu. U nejasnim slučajevima rađena je biopsija ili citološka punkcija tumora radi dobivanja tkivne dijagnoze. Tvrdoća tumora jetre primjenom ultrazvučne RT-2D-SWE značajno se razlikuje ovisno o histološkom tipu tumora. Benigni tumori mekaniji su u odnosu na maligne tumore jetre. Najtvrđi tumori su kolangiokarcinom i metastaze, zatim hepatocelularni karcinom i fokalna nodularna hiperplazija, a najmekši su hemangiomi. Maligni tumori međusobno se značajno razlikuju u vrijednostima omjera tvrdoće tumora prema tvrdoći jetre: kod HCC-a omjer je nizak jer HCC najčešće nastaje na podlozi ciroze koja je tvrda, dok su kod metastaza i CCC-a omjeri visoki s obzirom da oni najčešće nastaju u inače relativno zdravoj jetri. Zaključno, naši rezultati pokazuju da srednje vrijednosti tvrdoće tumora jetre izmjerene metodom RT-2D-SWE, te omjer tvrdoće tumora i parenhima jetre mogu posluţiti za neinvazivnu predikciju vrste tumora. Zbog preklapanja vrijednosti tvrdoće tumora kao i omjera tvrdoće tumora u odnosu na tvrdoću parenhima jetre, potreban je oprez te za sada nije moguće preporučiti isključivo oslanjanje na ovu metodu u određivanju vrste tumora jetre, već se RT-2D-SWE treba koristiti kao komplementarna metoda u dijagnostičkom algoritmu. |
| Abstract (english) | The final diagnosis of the liver tumors is obtained by liver biopsy, which is an invasive procedure and bring certian risk of complications. For that reason, researches are made to find non-invasive methods for characterization of liver tumors. One of the new methods is two-dimensional Real-Time Shear Wave Elastography (RT-2D-SWE). The goal of this research was to analyse the stiffness values of histological types of liver tumors with RT-2D-SWE. There has been 81 patients included in our research, of which 31 women and 50 men, with the average age of 55,2 years. In all patients, liver tumor has been found by the ultrasound, and tumor stiffnes, liver parenchyma stiffness and their ratio was measured by the RT-2D-SWE. Tumor type is obtained by standard algorithm for diagnosis, which includes tumor markers measement (AFP, CEA, CA 19-9, and in women CA 125) and one more radiological imaging method (MSCT and/or MR) using intravenous contrast. In the cases where the situation was not clear, we made biopsy or cytological punctuation of the tumor. Liver parenchyma stiffness was significantly different depending on histological type of the tumor. Benign tumors are softer than malignant. The stiffest tumors are cholangiocarcinoma and metastases, followed by HCC and FNH. The softest tumors are haemangiomas. The malignant tumors are mutually significantly different in tumor-to-liver parenchyma ratio values: the ratio for HCC was low because HCC grow in cirrhotic liver which is hard, while this ratio for metastasis an CCC is high, given that they grow in relatively healthy liver. Finally, our results show that the mean stiffness values obtained by RT-2D-SWE and the tumor-to-liver parenchyma ratio can be used for non-invasive prediction of the tumor type. Owing to the overlap in tumor stiffness and tumor-to-liver parenchyma ratio, it requires caution, and for the moment it is not possible to recommend exclusively this method for characterization tumor type. RT-2D-SWE should be used as complementary method in the diagnostic algorithm. |
