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The utility of post-biopsy ultrasonography in detecting complications after percutaneous liver biopsy in children

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Abstract

Background

Surveillance post image-guided percutaneous liver biopsy in children is variable.

Objective

The aim of this study was to assess the value of 4–6-h post-procedure ultrasonography (US) in detecting post-liver-biopsy hemorrhage.

Materials and methods

This prospective study included pediatric patients who underwent US-guided percutaneous liver biopsies. All children had a US study obtained pre-procedure and one obtained 4–6 h post-procedure; US examinations were deemed positive if abnormalities were present. We also reviewed any subsequent imaging that was performed within 7 days (late imaging) at the discretion of the referring team. Changes in US findings (ΔUS) were graded by two radiologists using a descriptive non-validated scale (none, minimal, marked). Hemoglobin (Hb) levels were assessed pre-procedure and 4 h post-procedure. The diagnostic accuracy of US changes for detecting post-procedural hemorrhage was calculated based on a drop in Hb >1.5 g/dL or Hb >15% from baseline (ΔHb). We used a Kruskal–Wallis test to correlate the ΔHb with ΔUS. Association between late-imaging and post-procedure US findings was tested using a chi-square test. We included 224 biopsies.

Results

The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post-procedure US in detecting post-procedure hemorrhage ranged 26.3–42.1%, 72.4–93.3%, 0.22–0.42, and 0.87–0.88, respectively. No significant association was seen between the ΔHb and sonographic findings (P=0.068). No significant difference was seen in the need for late imaging between children who did and those who did not have positive US findings (P=0.814).

Conclusion

The sensitivity and PPV of post-procedure US in detecting post-procedural hemorrhage are low. Our findings do not support routine post-procedure surveillance US.

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Acknowledgments

We acknowledge the help of all team members, fellows and staff from the Image Guided Therapy Centre during the study period.

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Authors and Affiliations

  1. Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    Gali Shapira-Zaltsberg, Bairbre Connolly, Micheal Temple, Dimitri A. Parra, Afsaneh Amirabadi & Joao G. Amaral

  2. University of Toronto, Toronto, ON, Canada

    Gali Shapira-Zaltsberg, Bairbre Connolly, Micheal Temple, Dimitri A. Parra, Afsaneh Amirabadi & Joao G. Amaral

Authors
  1. Gali Shapira-Zaltsberg
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  2. Bairbre Connolly
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  3. Micheal Temple
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  4. Dimitri A. Parra
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  5. Afsaneh Amirabadi
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  6. Joao G. Amaral
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Correspondence to Gali Shapira-Zaltsberg.

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Shapira-Zaltsberg, G., Connolly, B., Temple, M. et al. The utility of post-biopsy ultrasonography in detecting complications after percutaneous liver biopsy in children. Pediatr Radiol 50, 1717–1723 (2020). https://doi.org/10.1007/s00247-020-04783-1

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  • DOI: https://doi.org/10.1007/s00247-020-04783-1

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