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Contrast-enhanced ultrasound-guided musculoskeletal biopsies: our experience and technique

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Abstract

Objective

To present our experience with contrast-enhanced ultrasound (CEUS)-guided musculoskeletal soft tissue biopsies in a busy interventional clinic.

Materials and methods

After IRB approval was obtained and informed consent was waived, we retrospectively reviewed all CEUS-guided musculoskeletal biopsies performed from December 1, 2018 to March 2, 2020. Relevant pre-procedure imaging was reviewed. Number of samples, suspected necrosis on pre-procedure imaging, specimen adequacy for pathologic analysis, correlation with pathologic diagnosis of surgical resection specimens, and procedural complications were recorded.

Results

Thirty-six CEUS-guided musculoskeletal biopsies were performed in 32 patients (mean age 57, range 26–88; 22 males, 10 females). All procedures were performed using 16-gauge biopsy needles, and all procedures provided adequate samples for pathologic analysis as per the final pathology report. Between two and seven core specimens were obtained (mean 3.7). In 30/36 cases (83%), a contrast-enhanced MRI was obtained prior to biopsy, and 10/30 (33%) of these cases showed imaging features suspicious for necrosis. In 15/36 cases, surgical resection was performed, and the core biopsy and surgical resection specimens were concordant in 14/15 cases (93%). One patient noted transient leg discomfort at the time of microbubble bursting. Otherwise, no adverse reactions or procedural complications were observed.

Conclusion

CEUS is an accurate way to safely target representative areas of soft tissue lesions for biopsy and can be implemented in a busy interventional clinic. Our early experience has shown this to be a promising technique, especially in targeting representative areas of heterogeneous lesions and lesions with areas of suspected necrosis on prior imaging.

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Acknowledgments

The authors would like to acknowledge Erica Timm, RN, for her assistance with acquiring the data presented in this manuscript.

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Authors and Affiliations

  1. Department of Radiology, NYU Langone Heath, 660 First Avenue, New York, NY, 10016, USA

    Steven P. Daniels

  2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 E. Highland Avenue, Madison, WI, 53792, USA

    Lori Mankowski Gettle, Donna G. Blankenbaker, Kenneth S. Lee & Andrew B. Ross

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  1. Steven P. Daniels
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  2. Lori Mankowski Gettle
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  3. Donna G. Blankenbaker
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Correspondence to Steven P. Daniels.

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Conflict of interest

Dr. Daniels, Dr. Mankowski Gettle, and Dr. Ross have no conflicts of interest.

Dr. Blankenbaker is an author and consultant for Elsevier.

Dr. Lee has research grants from the NBA, GE and Mitek and receives in kind research support from Supersonic Imagine. He also receives royalties from Elsevier.

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This study has been accepted for presentation at the 2020 RSNA annual meeting scheduled for November 29–December 4, 2020.

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Daniels, S.P., Mankowski Gettle, L., Blankenbaker, D.G. et al. Contrast-enhanced ultrasound-guided musculoskeletal biopsies: our experience and technique. Skeletal Radiol 50, 673–681 (2021). https://doi.org/10.1007/s00256-020-03604-8

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  • DOI: https://doi.org/10.1007/s00256-020-03604-8

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