Assessment of Track Microbubble Flow Signals on Contrast-enhanced Ultrasound with Perflubutane Following Percutaneous Liver Biopsy

Abstract

Objective It is important to detect post-liver biopsy hemorrhage early and confirm hemostasis in the clinical setting. Contrast-enhanced ultrasound (CEUS) is a sensitive and highly specific tool for detecting active bleeding. The aim of this study was to investigate the rate of detection of track microbubble flow signals on CEUS with perflubutane following liver biopsy and to assess the disappearance of these signals.Methods Microbubble flow signals along the needle track on CEUS were examined in 100 patients who underwent percutaneous US-guided liver biopsies. The microbubble flow signals were examined repeatedly until their disappearance. The patients were followed up with clinical and laboratory data to detect clinically significant hemorrhaging. Results Microbubble flow signals on CEUS following percutaneous liver biopsy were seen in 33% of the patients. There were no significant differences in the platelet count, prothrombin time or length of the biopsy specimen between the patients with and those without microbubble flow signals on CEUS. The microbubble flow signals disappeared over time in all patients. There were no cases of clinically significant hemorrhaging in the present study. Conclusion Track microbubble flow signals on CEUS are frequently observed after biopsies. The disappearance of a microbubble flow signal is a useful index for confirming hemostasis of postbiopsy hemorrhaging.

Track Flow Signal on Ultrasound Power Doppler Along the Needle Tract Following Percutaneous Liver Biopsy

“…There are just few studies in the literature conduced where it is demonstration on CEUS. 1,2 We confirm that intraparenchymal flow signal along needle tract is also possible to be evaluate with the ultrasound power Doppler (Figure 1A-D) and is called "patent track" sign. The presence of either pulsatile arterial or venous waveforms in the patent track is not statistically associated with the severity of hemorrhage.…”

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

“…A total of 12 studies (all case series) fall into this miscellaneous section, which includes 4 categories of CEUS assisted procedures: (1) US‐guided abscess drainage; (2) US‐guided percutaneous nephrostomy; (3) US‐guided biliary interventions; and (4) hepatic and splenic hemorrhage. In the first 3 categories, a diluted contrast solution (ie, 0.1 mL of SonoVue in 20 mL of saline) is injected directly in the catheter or needle to visualize the exact location of the cavity or tissue around the catheter or needle tip: so‐called intracavitary CEUS.…”

“…Intravenous use of CEUS to detect and guide percutaneous treatment of splenic and hepatic hemorrhage or lesions after trauma or biopsy has been reported in 4 series, but only in 2 series was another imaging technique (CT) used as the reference standard, which resulted in a detection rate of 100% in both . Three of the studies reported on CEUS‐guided percutaneous treatment of hemorrhage .…”

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)

“…CEUS may be used to: a) Diagnose and monitor all stages of bleeding related to interventional procedures and guide percutaneous local application of hemostatic drugs [491,492]. b) Improve breast cancer staging by identifying and guiding biopsy of the sentinel node after intradermal CEUS if axillary B-mode US is normal [413].…”