Abstract
Introduction
Selection of the most appropriate modality for image guidance is essential for procedural success. We identified specific factors contributing to failure of ultrasound-guided procedures that were subsequently performed using CT guidance.
Materials and methods
This single-center, retrospective study included 164 patients who underwent a CT-guided biopsy, aspiration/drainage, or ablation after initially having the same procedure attempted unsuccessfully with ultrasound guidance. Review of the procedure images, reports, biopsy results, and clinical follow-up was performed and the reasons for inability to perform the procedure with ultrasound guidance were recorded. Patient cross-sectional area and depth to target were calculated. Differences in area and depth were compared using general linear modeling. Depth as a predictor of an unfavorable body habitus designation was modeled using logistic regression.
Results
US guidance was successful in the vast majority of cases (97%). Of the 164 procedures, there were 92 (56%) biopsies, 63 (38%) aspirations/drainages, and 9 (5%) ablations. The most common reason for procedure failure was poor acoustic window (83/164, 51%). Other reasons included target lesion being poorly discerned from adjacent tissue (61/164, 37%), adjacent bowel gas (34/164, 21%), body habitus (27/164, 16%), and gas-containing collection (22/164, 13%). Within the biopsy subgroup, patients for whom body habitus was a limiting factor were found to have on average a larger cross-sectional area and lesion depth relative to patients whose body habitus was not a complicating factor (p < 0.0001 and p = 0.0009).
Conclusion
Poor acoustic window was the most common reason for procedural failure with ultrasound guidance. In addition, as lesion depth increased, the odds that body habitus would limit the procedure also increased. If preliminary imaging suggests a limited sonographic window, particularly for deeper lesions, proceeding directly to CT guidance should be considered.
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Dr. Beland is a consultant for Hitachi Aloka, Inc. Dr. Dupuy has the following: Grant support: Medtronic, Galil Medical, Neuwave Medical. Board of Directors: Perseon Medical. Medical consultant: Perseon Medical. Honoraria: Educational Symposia. Royalities: Uptodate, Springer Verlag. Dr. Sternick, Dr. Cronan, Grayson Baird, and Dr. Mayo-Smith have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was waived by Institutional Review Board for this retrospective study.
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Beland, M.D., Sternick, L.A., Baird, G.L. et al. Optimizing modality selection for image-guided procedures: an analysis of the challenges to ultrasound guidance. Abdom Radiol 41, 590–599 (2016). https://doi.org/10.1007/s00261-016-0637-7
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DOI: https://doi.org/10.1007/s00261-016-0637-7