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