European Radiology

, Volume 20, Issue 8, pp 2047–2056 | Cite as

Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound

  • Soon Ho Yoon
  • Kyoung Ho LeeEmail author
  • So Yeon Kim
  • Young Hoon Kim
  • Jee Hyun Kim
  • Sang Hyub Lee
  • Tae Kyoung Kim



To prospectively evaluate the technical feasibility of percutaneous real-time contrast-enhanced ultrasound (CEUS) guided biopsy of focal hepatic lesions that are not confidently localised on B-mode US.


The study included 44 patients (mean age, 61.3 years) whose biopsy target could not be confidently localised on B-mode US performed by two independent radiologists. Biopsy was attempted under the guidance of both CEUS and B-mode US simultaneously displayed on a single monitor. Final diagnosis was established based on the pathological examination of the biopsy specimen as well as on clinical and radiological follow-up.


The size and depth of the target lesions were 18.0 ± 9.0 mm (mean ± SD) and 41.8 ± 17.2 mm respectively. Five patients with negative or indistinct CEUS findings did not undergo biopsy, while 39 patients completed the biopsy. In 38 of the 39 patients, the biopsy result was concordant with the final diagnosis. In the remaining one patient, the biopsy failed to prove metastasis. As there were six cases of technical failure, the technical success rate was 86% (38/44). The sensitivity in diagnosing malignancy was 88% (30/34).


Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localised on B-mode US.


Contrast-enhanced ultrasound Harmonic imaging Biopsy 



This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by Ministry of Science and Technology (MOST), Republic of Korea (no. R01–2008–000–10055–0).

Supplementary material

Movie 1

Hepatic eosinophilic abscess in a 70-year-old man with melanoma. Under the guidance of oblique intercostal contrast-enhanced ultrasound (left) and B-mode ultrasound (right), a biopsy needle was successfully placed for the target lesion (MOV 4.36 MB) (3.2 mb)
Movie 2 Hepatic metastasis from glottic cancer in a 57-year-old man. The target lesion is invisible on oblique intercostal B-mode ultrasound (MOV 3.18 MB)
Movie 3

Marginal recurrence following radiofrequency ablation of hepatic metastases from gastric cancer in a 72-year-old man. On transverse subcostal B-mode ultrasound, the target lesion (viable tumor) and the surrounding previously ablated tumours appear as a single conglomerate mass (MOV 2.57 MB)


  1. 1.
    Bravo AA, Sheth SG, Chopra S (2001) Liver biopsy. N Engl J Med 344:495–500CrossRefPubMedGoogle Scholar
  2. 2.
    Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF (2002) Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR Imaging, PET): a meta-analysis. Radiology 224:748–756CrossRefPubMedGoogle Scholar
  3. 3.
    Teefey SA, Hildeboldt CC, Dehdashti F, Siegel BA, Peters MG, Heiken JP, Brown JJ, McFarland EG, Middleton WD, Balfe DM, Ritter JH (2003) Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. Radiology 226:533–542CrossRefPubMedGoogle Scholar
  4. 4.
    Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK (2008) Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. Am J Roentgenol 190:1324–1330CrossRefGoogle Scholar
  5. 5.
    Albrecht T, Blomley MJ, Burns PN, Wilson S, Harvey CJ, Leen E, Claudon M, Calliada F, Correas JM, LaFortune M, Campani R, Hoffmann CW, Cosgrove DO, LeFevre F (2003) Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study. Radiology 227:361–370CrossRefPubMedGoogle Scholar
  6. 6.
    Chami L, Lassau N, Malka D, Ducreux M, Bidault S, Roche A, Elias D (2008) Benefits of contrast-enhanced sonography for the detection of liver lesions: comparison with histologic findings. Am J Roentgenol 190:683–690CrossRefGoogle Scholar
  7. 7.
    Catalano O, Nunziata A, Lobianco R, Siani A (2005) Real-time harmonic contrast material-specific US of focal liver lesions. Radiographics 25:333–349CrossRefPubMedGoogle Scholar
  8. 8.
    Minami Y, Kudo M, Chung H, Kawasaki T, Yagyu Y, Shimono T, Shiozaki H (2007) Contrast harmonic sonography-guided radiofrequency ablation therapy versus B-mode sonography in hepatocellular carcinoma: prospective randomized controlled trial. Am J Roentgenol 188:489–494CrossRefGoogle Scholar
  9. 9.
    Minami Y, Kudo M, Kawasaki T, Chung H, Ogawa C, Shiozaki H (2004) Treatment of hepatocellular carcinoma with percutaneous radiofrequency ablation: usefulness of contrast harmonic sonography for lesions poorly defined with B-mode sonography. Am J Roentgenol 183:153–156Google Scholar
  10. 10.
    Bang N, Bachmann Nielsen M, Vejborg I, Mellon Mogensen A (2000) Clinical report: contrast enhancement of tumor perfusion as a guidance for biopsy. Eur J Ultrasound 12:159–161CrossRefPubMedGoogle Scholar
  11. 11.
    Schlottmann K, Klebl F, Zorger N, Feuerbach S, Scholmerich J (2004) Contrast-enhanced ultrasound allows for interventions of hepatic lesions which are invisible on conventional B-mode. Z Gastroenterol 42:303–310CrossRefPubMedGoogle Scholar
  12. 12.
    Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872CrossRefPubMedGoogle Scholar
  13. 13.
    Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236CrossRefPubMedGoogle Scholar
  14. 14.
    Lencioni R (2006) Impact of European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on the use of contrast agents in liver ultrasound. Eur Radiol 16:1610–1613CrossRefPubMedGoogle Scholar
  15. 15.
    Chojniak R, Isberner RK, Viana LM, Yu LS, Aita AA, Soares FA (2006) Computed tomography guided needle biopsy: experience from 1,300 procedures. Sao Paulo Med J 124:10–14CrossRefPubMedGoogle Scholar
  16. 16.
    Stattaus J, Maderwald S, Baba HA, Gerken G, Barkhausen J, Forsting M, Ladd ME (2008) MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system. Eur Radiol 18:2865–2873CrossRefPubMedGoogle Scholar
  17. 17.
    Wu W, Chen MH, Yin SS, Yan K, Fan ZH, Yang W, Dai Y, Huo L, Li JY (2006) The role of contrast-enhanced sonography of focal liver lesions before percutaneous biopsy. Am J Roentgenol 187:752–761CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Soon Ho Yoon
    • 1
  • Kyoung Ho Lee
    • 1
    Email author
  • So Yeon Kim
    • 1
  • Young Hoon Kim
    • 1
  • Jee Hyun Kim
    • 2
  • Sang Hyub Lee
    • 2
  • Tae Kyoung Kim
    • 3
  1. 1.Department of Radiology, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnam-siKorea
  2. 2.Department of Internal Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulKorea
  3. 3.Department of Medical Imaging, Toronto General HospitalUniversity of TorontoTorontoCanada

Personalised recommendations