Abstract: Objective The purpose of this study was to investigate the diagnostic performance of dynamic three-dimensional contrast-enhanced ultrasound (CEUS) in combination with shear wave elastography (SWE) in distinguishing benign from malignant focal liver lesions (FLL). Methods A total of 106 patients with FLL were encountered in our hospital between January 2020 and January 2024, and all patients underwent CEUS to record time to peak (TTP), peak intensity (PI), enhancement time (ET) and enhancement slope (ES), and underwent SWE examinations to record Young's modulus. Diagnosis was made by histopathological examination. Multivariate Logistic regression analysis was used to screen factors hinting malignant lesions, and the receiver operating characteristic (ROC) curve was applied to evaluate diagnostic efficacy of CEUS and SWE in assessing benignity or malignancy of the lesions. Results Of the 106 patients with FLL, histopathological examination found malignant lesions in 39 cases and benign ones in 67 cases; TTP and ET in malignant lesions were (25.7±2.4)s and (19.8±1.9)s,both much lower than [(30.9±3.3)s and (23.9±2.7)s,respectively, P＜0.05],while PI, ES and Yang’s modulus were (26.9±2.8)dB, (2.2±0.6) and (24.2±3.4)kPa,all much higher than [(22.6±2.2)dB, (1.0±0.4) and (18.4±2.2)kPa,respectively, P＜0.05] in benign lesions; multivariate Logistic regression analysis showed that increased PI, ES and Yang’s modulus highly pointing out malignant, while increased TTP and ET eliminating malignant lesions (P＜0.05); ROC analysis demonstrated that CEUS in combination with SWE had a high differentiating performance of malignant and benign intrahepatic lesions, with sensitivity of 94.9% and specificity of 97.0%. Conclusion Dynamic three-dimensional CEUS and SWE combination has a high diagnostic efficacy in distinguishing benign from malignant lesions of livers.

Key words: Focal liver lesions, Contrast-enhanced ultrasound, Shear wave elastography, Qualitative diagnosis