INTERVENTIONAL RADIOLOGY / REVIEW PAPER
Application of contrast-enhanced ultrasound in liver biopsy
More details
Hide details
1
Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
2
Students’ Scientific Circle of Radiology, Jagiellonian University Medical College, Krakow, Poland
Submission date: 2025-02-04
Final revision date: 2025-03-25
Acceptance date: 2025-03-25
Publication date: 2025-06-06
Corresponding author
Andrzej Fedak
Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
Pol J Radiol, 2025; 90: 292-298
KEYWORDS
TOPICS
ABSTRACT
The aim of this study is to determine the usefulness of contrast-enhanced ultrasound (CEUS) in liver biopsy. The popularisation of imaging techniques that visualise the abdominal cavity, especially ultrasonography (USG), has resulted in an increase in the detection of focal liver lesions (FLL). If the results of other imaging modalities (magnetic resonance imaging [MRI] or computed tomography [CT]) are inconclusive, percutaneous liver biopsy should be considered. Taking into account the limitations of using MRI and CT in liver biopsy, this procedure is mostly performed with ultrasound. It is economical, safe, and swift. Whenever it is impossible to visualise lesions in B-mode (a condition necessary for a safe and effective biopsy), it is advisable to use advanced ultrasound techniques – CEUS or fusion imaging. Limitations of fusion imaging include prolonged time of data processing and difficulties in achieving optimal overlap of images. Conversely, CEUS enhances lesion visualisation but is devoid of the mentioned limitations – it is rapid and requires no additional processing.
Furthermore, considering the potential of CEUS in the visualisation of focal liver lesions and differentiation of necrotic areas, accompanied by the ability to detect neuroendocrine tumours or its metastasis, we strongly believe that biopsy procedures – especially core needle biopsies – with CEUS assistance are potent tools in contemporary diagnostics. In this paper we want to share the experience of our centre and review the available literature on performing liver biopsies under CEUS guidance.
REFERENCES (21)
1.
Kaltenbach TEM, Engler P, Kratzer W, Oeztuerk S, Seufferlein T, Haenle MM, et al. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdom Radiol 2016; 41: 25-32.
2.
Chiche L, Adam JP. Diagnosis and Management of Benign Liver Tumors. Semin Liver Dis 2013; 33: 236-347.
3.
Sawatzki M, Husarik DB, Semela D. Assessment of focal liver lesions in non-cirrhotic liver – expert opinion statement by the swiss association for the study of the liver and the Swiss Society of Gastroenterology. Swiss Med Wkly 2023; 153: 40099-40099.
4.
Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG clinical guideline: focal liver lesions. Am J Gastroenterol 2024; 119: 1235-1271.
5.
Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69: 1382-1403.
6.
Pang EHT, Harris AC, Chang SD. Approach to the Solitary liver lesion: imaging and when to biopsy. Can Assoc Radiol J 2016; 67: 130-148.
7.
Sauter AP, Proksa R, Knipfer A, Reischl S, Braren RF, Nadjiri J, et al. CT-guided liver biopsy: evaluation of spectral data from dual-layer detector CT for improved lesion detection. Cardiovasc Intervent Radiol 2023; 46: 1621-1631.
8.
Vijayaraghavan GR, Sheehan D, Bermudez-Allende M, Sarwat H. Imaging-guided parenchymal liver biopsy: How we do it. J Clin Imaging Sci 2011; 1: 30.
9.
Lorentzen T, Nolsoe C. The role of US contrast agents in US-guided biopsy of focal liver lesions: a pictorial review. Ultrasound Int Open 2019; 5: E11-E19.
10.
Dietrich C, Averkiou M, Nielsen M, Barr RG, Burns PN, Calliada F, et al. How to perform contrast-enhanced ultrasound (CEUS). Ultrasound Int Open 2018; 4: E2-E15.
11.
Polaków J, Janica J, Serwatka W, Ladny JR, Zukowska-Serwatka K. Value of three-dimensional sonography in biopsy of focal liver lesions. J Hepatobiliary Pancreat Surg 2003; 10: 87-89.
12.
Omar H, Korayem E, Khalil A, Abokoura S. Added value of 3D ultrasound image-guided hepatic interventions by X matrix technology. Egypt J Radiol Nucl Med 2023; 54. DOI: 10.1186/s43055-023-01138-2.
13.
Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography 2014; 33: 227-239.
14.
Chiorean L, Tana C, Braden B, Caraiani C, Sparchez Z, Cui XW, et al. Advantages and limitations of focal liver lesion assessment with ultrasound contrast agents: comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines. Med Princ Pract 2016; 25: 399-407.
15.
Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34: 11-29.
16.
Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, et al. Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver – update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 2020; 46: 2579-2604.
17.
Partovi S, Lu Z, Kessner R, Yu A, Ahmed Y, Patel IJ, et al. Contrast enhanced ultrasound guided biopsies of liver lesions not visualized on standard B-mode ultrasound-preliminary experience. J Gastrointest Oncol 2017; 8: 1056-1064.
18.
Giampiero F, Meloni MF, de Sio I, Terracciano F, Caturelli E, Riccardi L, et al. Biopsy of liver target lesions under contrast-enhanced ultrasound guidance – a multi-center study. Ultraschall Med 2018; 39: 448-453.
19.
Sparchez Z, Mocan T, Hagiu C, Kacso G, Zaharie T, Rusu I, et al. Real-time contrast-enhanced-guided biopsy compared with conventional ultrasound-guided biopsy in the diagnosis of hepatic tumors on a background of advanced chronic liver disease: a prospective, randomized, clinical trial. Ultrasound Med Biol 2019; 45: 2915-2924.
20.
Kang M, Ragan BG, Park JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train 2008; 43: 215-221.
21.
Wu W, Jing X, Xue GQ, Zhu XL, Wang J, Du RQ, et al. A multicenter randomized controlled study of contrast-enhanced US versus US-guided biopsy of focal liver lesions. Radiology 2022; 305: 721-728.