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

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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

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Acknowledgements

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).

Author information

Correspondence to Kyoung Ho Lee.

Electronic supplementary material

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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)

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)

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)

Appendix. Questionnaire for B-mode ultrasound findings

Appendix. Questionnaire for B-mode ultrasound findings

If a target lesion was never visible, choose one of the following reasons:

  1. (a)

    Isoechoic in comparison to the surrounding hepatic parenchyma

  2. (b)

    Located in a sonographically blind area

  3. (c)

    Poor ultrasound penetration due to severe fatty liver or large body habitus

  4. (d)

    Others. Describe ______

If any target lesion was visible with any confidence, choose one of the following reasons:

  1. (e)

    Too indistinct to guide a needle or to be verified as a true lesion

  2. (f)

    Unable to discriminate non-necrotic portion from necrotic portion in the lesion

  3. (g)

    Others. Describe ______

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Yoon, S.H., Lee, K.H., Kim, S.Y. et al. Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound. Eur Radiol 20, 2047–2056 (2010) doi:10.1007/s00330-010-1757-z

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Keywords

  • Contrast-enhanced ultrasound
  • Harmonic imaging
  • Biopsy