Advertisement

Abdominal Radiology

, Volume 43, Issue 12, pp 3279–3287 | Cite as

Additional value of contrast-enhanced ultrasonography for fusion-guided, percutaneous biopsies of focal liver lesions: prospective feasibility study

  • Hyo-Jin Kang
  • Jung Hoon KimEmail author
  • Sang Min Lee
  • Hyun Kyung Yang
  • Su Joa Ahn
  • Joon Koo Han
Article

Abstract

Purpose

To determine the value of CEUS for real-time, fusion-guided, percutaneous biopsies of focal liver lesions.

Materials and methods

Institutional review board approval and written informed consents were obtained for this study. Forty patients with focal liver lesions identified on CT/MRI were prospectively enrolled. For biopsy planning, real-time fusion of CT/MRI with USG (USG-Fusion) was performed, and subsequently real-time CEUS was fused with CT/MRI (CEUS-Fusion). We evaluated lesion visibility, confidence level of technical success before the procedure, and safety route accessibility on USG-Fusion and CEUS-Fusion. Occurrence of change in the biopsy target was also assessed.

Results

Among 40 target lesions, nine (22.5%) lesions were invisible on USG-Fusion. After applying CEUS-Fusion, seven of nine (77.8%) lesions were visualized. Confidence level of technical success of procedure was significantly increased on CEUS-Fusion compared USG-Fusion (p = 0.02), and presumed target lesions were changed in 16 (40%) patients after CEUS-Fusion. As the lesion is necrotic, presumed target was more frequently changed after CEUS-Fusion (50.0% and 25.0%). Confirmative diagnostic results were reported in 39 (97.5%) patients. Accessibility of the safety route to target lesions did not reach statistical differences.

Conclusion

Applying a new, real-time CEUS-Fusion with CT/MRI improved tumor visibility and viable portion assessment, thus leading to higher operator confidence and diagnostic yield, when compared with conventional USG-Fusion.

Keywords

Liver Neoplasm Biopsy Ultrasound imaging Contrast agent 

Notes

Acknowledgements

We also thank Bonnie Hami, M.A. (USA) for her editorial assistance in the preparation of this manuscript.

Compliance with ethical standards

Funding

This research was partially supported by a research grant from SAMSUNG MEDISON Co., Ltd. and by a research grant from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1A2B4004951).

Conflict of interest

Jung Hoon Kim has received research grant from SAMSUNG MEDISON. Other authors confirm that there are no potential conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. This prospective study was approved by our Institutional Review Board. All patients provided informed consent before their CEUS and biopsy procedure.

References

  1. 1.
    Elsayes KM, et al. (2011) Diagnostic yield of percutaneous image-guided tissue biopsy of focal hepatic lesions in cancer patients. Cancer 117(17):4041–4048CrossRefGoogle Scholar
  2. 2.
    Francque S, et al. (2002) Biopsy of focal liver lesions: guidelines, comparison of techniques and cost-analysis. Acta Gastro-enterologica Belgica 66(2):160–165Google Scholar
  3. 3.
    Lencioni R, Caramella D, Bartolozzi C (1995) Percutaneous biopsy of liver tumors with color Doppler US guidance. Abdom Imaging 20(3):206–208CrossRefGoogle Scholar
  4. 4.
    Polaków J, et al. (2003) Value of three-dimensional sonography in biopsy of focal liver lesions. J Hepato-Biliary-Pancreatic Sci 10(1):87–89Google Scholar
  5. 5.
    Diederich S, et al. (2006) Application of a single needle type for all image-guided biopsies: results of 100 consecutive core biopsies in various organs using a novel tri-axial, end-cut needle. Cancer Imaging 6(1):43CrossRefGoogle Scholar
  6. 6.
    Park HJ, et al. (2013) Fusion imaging–guided percutaneous biopsy of focal hepatic lesions with poor conspicuity on conventional sonography. J Ultrasound Med 32(9):1557–1564CrossRefGoogle Scholar
  7. 7.
    Jung E, et al. (2009) New real-time image fusion technique for characterization of tumor vascularisation and tumor perfusion of liver tumors with contrast-enhanced ultrasound, spiral CT or MRI: first results. Clin Hemorheol Microcirc 43(1–2):57–69PubMedGoogle Scholar
  8. 8.
    Lee MW, et al. (2013) Planning US for percutaneous radiofrequency ablation of small hepatocellular carcinomas (1–3 cm): value of fusion imaging with conventional US and CT/MR images. J Vasc Interv Radiol 24(7):958–965CrossRefGoogle Scholar
  9. 9.
    Lim S, et al. (2014) Mistargeting after fusion imaging-guided percutaneous radiofrequency ablation of hepatocellular carcinomas. J Vasc Interv Radiol 25(2):307–314CrossRefGoogle Scholar
  10. 10.
    Quaia E, et al. (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride–filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232(2):420–430CrossRefGoogle Scholar
  11. 11.
    Claudon M, et al. (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver–update 2012. Eur J Ultrasound 34(01):11–29Google Scholar
  12. 12.
    Yoon SH, et al. (2010) Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound. Eur Radiol 20(8):2047–2056CrossRefGoogle Scholar
  13. 13.
    Sparchez Z, et al. (2011) Usefulness of contrast enhanced ultrasound guidance in percutaneous biopsies of liver tumors. J Gastrointestin Liver Dis 20(2):191–196PubMedGoogle Scholar
  14. 14.
    Wu W, et al. (2006) The role of contrast-enhanced sonography of focal liver lesions before percutaneous biopsy. Am J Roentgenol 187(3):752–761CrossRefGoogle Scholar
  15. 15.
    Min JH, et al. (2014) Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US. Clin Mol Hepatol 20(1):61CrossRefGoogle Scholar
  16. 16.
    Minami T, et al. (2014) Combination guidance of contrast-enhanced US and fusion imaging in radiofrequency ablation for hepatocellular carcinoma with poor conspicuity on contrast-enhanced US/fusion imaging. Oncology 87(Suppl 1):55–62CrossRefGoogle Scholar
  17. 17.
    Bang N, et al. (2000) Clinical report: contrast enhancement of tumor perfusion as a guidance for biopsy. Eur J Ultrasound 12(2):159–161CrossRefGoogle Scholar
  18. 18.
    Francica G et al. (2017) Biopsy of liver target lesions under contrast-enhanced ultrasound guidance-a multi-center study. Ultraschall in der Medizin (Stuttgart, Germany: 1980)Google Scholar
  19. 19.
    Solbiati L, et al. (2001) The role of contrast-enhanced ultrasound in the detection of focal liver leasions. Eur Radiol 11:E15–E26CrossRefGoogle Scholar
  20. 20.
    Catalano O, et al. (2005) Real-time harmonic contrast material–specific US of focal liver lesions. Radiographics 25(2):333–349CrossRefGoogle Scholar
  21. 21.
    Schlottmann K, et al. (2004) Contrast-enhanced ultrasound allows for interventions of hepatic lesions which are invisible on convential B-mode. Zeitschrift für Gastroenterologie 42(04):303–310CrossRefGoogle Scholar
  22. 22.
    Solbiati L, et al. (2004) Guidance and monitoring of radiofrequency liver tumor ablation with contrast-enhanced ultrasound. Eur J Radiol 51:S19–S23CrossRefGoogle Scholar
  23. 23.
    Jung EM, et al. (2012) Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions: first results. PLoS ONE 7(3):e33956CrossRefGoogle Scholar
  24. 24.
    Kang TW, et al. (2017) Added value of contrast-enhanced ultrasound on biopsies of focal hepatic lesions invisible on fusion imaging guidance. Korean J Radiol 18(1):152–161CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hyo-Jin Kang
    • 1
  • Jung Hoon Kim
    • 1
    • 2
    Email author
  • Sang Min Lee
    • 3
  • Hyun Kyung Yang
    • 4
  • Su Joa Ahn
    • 1
  • Joon Koo Han
    • 1
    • 2
  1. 1.Department of RadiologySeoul National University HospitalSeoulKorea
  2. 2.Institute of Radiation MedicineSeoul National University College of MedicineSeoulKorea
  3. 3.Department of RadiologyHallym University Sacred Heart HospitalAnyangKorea
  4. 4.Department of Medical ImagingToronto General Hospital, University of TorontoTorontoCanada

Personalised recommendations