Percutaneous liver biopsy in difficult cases simplified by CT or ultrasonic localization

Abstract

Repeat liver biopsy guided by CT and ultrasound was performed in ten prospectively selected patients with chronic liver disease, small liver size, and a previous unsuccessful biopsy. Biopsy sites selected by both radiographic techniques were essentially similar and within 1 cm of each other. The bulk of the liver was located more posteriorly and superiorly than expected, explaining the failure of the previous unsuccessful biopsies. Adequate cores of liver 1-2.5 cm in length were easily obtained with radiologic guidance. This technique is especially useful in patients with chronic active hepatitis complicated by cirrhosis.

Influence of operator experience on performance of ultrasound-guided percutaneous liver biopsy

“…Ultrasound guidance, introduced in the late 1970s [1,2] and used in the 1990s in 12-56% of procedures in some European countries [3][4][5][6][7], is a cost-effective method [8,9], obviating the need for multiples passes [10], reducing the failure rate of PLB and decreasing the rate of complications, including pain [3,8,[11][12][13][14]. Development of semi-automated and automated needles have also taken place to increase the quality of specimens [13,15], and biopsies are easier to perform with such devices than with cutting-type or aspiration-type manual needles.…”

Computed Tomography of the Liver

“…Hepatomas can be detected as mass lesions with the same nonspecific CT findings as discussed previously [14]. Both ultrasonography and CT can be used for guided percutaneous biopsy of the small cirrhotic liver, particularly in patients whose cirrhosis is secondary to chronic active hepatitis [5]. In these patients, the liver span is often difficult to define by clinical percussion, and guided biopsy results in a satisfactory specimen without complications such as pneumothorax or kidney puncture or resort to laparoscopy.…”