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



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.


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.


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.


Liver Neoplasm Biopsy Ultrasound imaging Contrast agent 



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

Compliance with ethical standards


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.


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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

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