Clinical utility of real-time ultrasound-multimodality fusion guidance for percutaneous biopsy of focal liver lesions

Su Joa Ahn; Jeong Min Lee; Won Chang; Sang Min Lee; Hyo-Jin Kang; Hyun-Kyung Yang; Joon Koo Han

doi:10.1016/j.ejrad.2018.04.002

Clinical utility of real-time ultrasound-multimodality fusion guidance for percutaneous biopsy of focal liver lesions

Eur J Radiol. 2018 Jun:103:76-83. doi: 10.1016/j.ejrad.2018.04.002. Epub 2018 Apr 4.

Authors

Su Joa Ahn¹, Jeong Min Lee², Won Chang³, Sang Min Lee⁴, Hyo-Jin Kang¹, Hyun-Kyung Yang¹, Joon Koo Han⁵

Affiliations

¹ Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
² Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: jmsh@snu.ac.kr.
³ Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
⁴ Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
⁵ Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

PMID: 29803390
DOI: 10.1016/j.ejrad.2018.04.002

Abstract

Objectives: To prospectively evaluate the clinical value of real-time ultrasonography (US)-computed tomography (CT)/magnetic resonance imaging (MRI) fusion imaging for percutaneous needle biopsy of focal liver lesions (FLLs), and to compare its biopsy success rate with that of conventional US-guided biopsy in a propensity-score matched group.

Methods: This study was approved by our Institutional Review Board and informed consent was obtained from all patients enrolled in the prospective study group. Ninety patients referred to the Department of Radiology for percutaneous biopsy of FLLs were enrolled in this study. Tumor visibility, attainment of a safe access route, and technical feasibility were assessed on conventional US first and later on real-time fusion imaging by one of four abdominal radiologists. Thereafter, differences in scores between real-time fusion imaging and conventional US were determined. In addition, overall diagnostic success rates of a real-time fusion imaging-guided biopsy group and a propensity-score matched, conventional US-guided biopsy group, consisting of 100 patients used as historical control, were compared.

Results: With real-time fusion imaging, tumor visibility, attainment of a safe access route, and operator's technical feasibility were significantly improved compared with conventional US (P < .001). In addition, all invisible (n = 13) and not feasible (n = 10) FLLs on conventional US became visible and feasible for percutaneous US-guided biopsy after applying the fusion system. The diagnostic success rate of real-time fusion-guided biopsy was 94.4% (85/90), which was significantly better than that obtained with the conventional US-guided biopsy (94.4% vs. 83%, P < .03), with reduced biopsy procedure times (7.1 ± 3.5 vs. 9.7 ± 2.8, P < .02).

Conclusions: Real-time US-CT/MR fusion imaging guidance was able to provide clinical value for percutaneous needle biopsy of FLLs by improving the diagnostic success rate of biopsy and by reducing procedure time.

Keywords: Biopsy; Feasibility; Focal liver lesion; Fusion imaging; Ultrasonography; Visibility.

MeSH terms

Adult
Aged
Aged, 80 and over
Biopsy, Needle
Female
Humans
Image-Guided Biopsy / methods
Liver / diagnostic imaging
Liver Neoplasms / diagnostic imaging*
Magnetic Resonance Imaging, Interventional / methods*
Male
Middle Aged
Multimodal Imaging / methods*
Prospective Studies
Radiography, Interventional / methods
Reproducibility of Results
Tomography, X-Ray Computed / methods*
Ultrasonography / methods
Ultrasonography, Interventional / methods*