Analytical Study of Ultrasound Elastography Diagnostic Performance for Focal Liver Lesions at Tertiary Hospitals in South South Nigeria

Ultrasound elastography is an emerging diagnostic imaging technique that quantifies tissue stiffness to differentiate benign from malignant liver lesions, potentially providing a non-invasive alternative to liver biopsy in resource-limited settings. Its diagnostic performance for focal liver lesions in South South Nigerian tertiary hospitals, where hepatocellular carcinoma burden is high, has not been analytically evaluated. This study analytically evaluates the diagnostic performance of ultrasound elastography for characterising focal liver lesions at tertiary hospitals in Rivers, Edo, and Delta States. A prospective correlative design is applied to 180 patients with focal liver lesions identified on conventional ultrasound at University of Port Harcourt Teaching Hospital, University of Benin Teaching Hospital, and Delta State University Teaching Hospital. Point shear wave elastography values are measured alongside conventional B-mode characteristics, with histopathological examination or CT-MRI composite imaging serving as the reference standard. Sensitivity, specificity, area under the ROC curve, and optimal stiffness cut-off values for malignancy classification are computed in SPSS. Available hepatic elastography literature from South South Nigeria identifies the scarcity of elastography diagnostic performance data in West African populations as the principal research gap, despite the high hepatocellular carcinoma burden. The EFSUMB Guidelines on Elastography and WFUMB guidelines on liver ultrasound provide the diagnostic reference framework. Findings are expected to provide the first empirical elastography diagnostic performance data for South South Nigeria. Recommendations address elastography protocol standardisation and radiographer competency training at South South tertiary hospitals. Keywords: elastography, focal liver lesions, diagnostic performance, South South Nigeria, hepatocellular carcinoma.