Added Value of Contrast-Enhanced Ultrasound on Biopsies of Focal Hepatic Lesions Invisible on Fusion Imaging Guidance

Abstract

ObjectiveTo assess whether contrast-enhanced ultrasonography (CEUS) with Sonazoid can improve the lesion conspicuity and feasibility of percutaneous biopsies for focal hepatic lesions invisible on fusion imaging of real-time ultrasonography (US) with computed tomography/magnetic resonance images, and evaluate its impact on clinical decision making.Materials and MethodsThe Institutional Review Board approved this retrospective study. Between June 2013 and January 2015, 711 US-guided percutaneous biopsies were performed for focal hepatic lesions. Biopsies were performed using CEUS for guidance if lesions were invisible on fusion imaging. We retrospectively evaluated the number of target lesions initially invisible on fusion imaging that became visible after applying CEUS, using a 4-point scale. Technical success rates of biopsies were evaluated based on histopathological results. In addition, the occurrence of changes in clinical decision making was assessed.ResultsAmong 711 patients, 16 patients (2.3%) were included in the study. The median size of target lesions was 1.1 cm (range, 0.5–1.9 cm) in pre-procedural imaging. After CEUS, 15 of 16 (93.8%) focal hepatic lesions were visualized. The conspicuity score was significantly increased after adding CEUS, as compared to that on fusion imaging (p < 0.001). The technical success rate of biopsy was 87.6% (14/16). After biopsy, there were changes in clinical decision making for 11 of 16 patients (68.8%).ConclusionThe addition of CEUS could improve the conspicuity of focal hepatic lesions invisible on fusion imaging. This dual guidance using CEUS and fusion imaging may affect patient management via changes in clinical decision-making.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…However, one of the main challenges during US-guided biopsy is poor lesion conspicuity on conventional B-mode US [134]. When biopsy targets are not well depicted or not visualized on conventional B-mode US, the use of Sonazoid can be helpful to enhance the visualization of targets [53,135,136]. Lesion detection rates were significantly improved during the vascular phase (84.0%) and postvascular phase (Kupffer phase) (92.3%) in comparison to conventional B-mode US (77.3%) [136].…”

“…One limitation of this study was that the choice of B-mode US and Sonazoid CEUS was based on the operator's decision, and not based on the predetermined criteria. The reported technical success rates on Sonazoid CEUS ranges from 87.6% to 92.3%; these numbers are quite high considering that biopsy cannot be even attempted without the use of Sonazoid [53,135,136].…”

“…Fusion imaging can also help address issues with poor visualization using conventional B-mode US [137,138]. The combination of fusion imaging and CEUS can be a powerful tool to improve lesion conspicuity and technical feasibility of liver biopsy [135]. In addition to better lesion conspicuity, Sonazoid CEUS is beneficial in terms of long-lasting visibility during the postvascular phase (Kupffer phase).…”

Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals

“…In total, 50 KJR (9101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354565758), 492 ER, and 254 Radiology articles reported original research studies analyzing patient data. Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month.…”

“…Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month. The point estimate value of this proportion was slightly larger in KJR than in ER and Radiology, although the difference was not statistically significant.…”