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CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate Cover

CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate

Open Access
|Jun 2023

Figures & Tables

FIGURE 1.

The Standards for the Reporting of Diagnostic Accuracy studies (STARD) flow diagram for a study of 607 patients undergoing CT-guided liver biopsy.
The Standards for the Reporting of Diagnostic Accuracy studies (STARD) flow diagram for a study of 607 patients undergoing CT-guided liver biopsy.

FIGURE 2.

The decision for a biopsy of the suspicious hepatic lesion was made for the same male patient. Because of the small lesion size and isodensity in the unenhanced CT, a prior intra-arterial Lipiodol-marking (A) was performed. Directly after the intervention (B) and during the CT intervention (C) (white arrow) was well displayable, and the biopsy was successful, revealing a hepatocellular carcinoma.
The decision for a biopsy of the suspicious hepatic lesion was made for the same male patient. Because of the small lesion size and isodensity in the unenhanced CT, a prior intra-arterial Lipiodol-marking (A) was performed. Directly after the intervention (B) and during the CT intervention (C) (white arrow) was well displayable, and the biopsy was successful, revealing a hepatocellular carcinoma.

FIGURE 3.

A male patient with a suspect and unclear hepatic lesion with 6 mm in segment 7. While not visible in the unenhanced CT (A), the lesion impressed arterial hypervascularized after intravenous contrast medium application (B) (white arrow).
A male patient with a suspect and unclear hepatic lesion with 6 mm in segment 7. While not visible in the unenhanced CT (A), the lesion impressed arterial hypervascularized after intravenous contrast medium application (B) (white arrow).

FIGURE 4.

Presentation of histopathologically correlated puncture successes for the overall cohort and individual groups individually.
Presentation of histopathologically correlated puncture successes for the overall cohort and individual groups individually.

Overview of patient characteristics_ P-values based on the Chi-square test indicate only a difference in the distribution of liver cirrhosis in comparison of the three enhancement groups

CharacteristicOverallUnenhanced biopsyLipiodol-enhancedi.v. contrast-enhancedp-value
Age, y (SD)61.0 ± 12.061.9 ± 11.9560.4 ± 11.1259.6 ± 13.040.228
Gender, n (%)0.134
  Male358 (59.0)177 (55.1)108 (74.5)73 (51.8)
  Female249 (41.0)144 (44.9)37 (25.5)68 (48.2)
Hepatic disease, n (%)0.354
  HCV101 (16.6)34 (10.6)53 (36.6)14 (9.9)
  HBV28 (4.6)6 (1.9)17 (11.7)5 (3.5)
  HCV+HBV8 (1.3)3 (0.9)3 (2.1)2 (1.4)
  NASH34 (5.6)12 (3.7)17 (11.7)5 (3.5)
  Toxic damage48 (7.9)20 (6.2)16 (11.0)12 (8.5)
  Others53 (8.7)26 (8.1)19 (13.1)8 (5.7)
  No disease335 (55.2)220 (68.5)20 (13.8)95 (67.4)
Cirrhosis188 (33.0)59 (19.2)100 (71.9)29 (3.6)0.013
Intrahepatic lesions, n (%)0.541
  1 lesion297 (48.9)164 (51.1)68 (46.9)65 (46.1)
  2 lesions116 (19.1)45 (14.0)37 (25.5)34 (24.1)
  3 or more lesions194 (32.0)112 (34.9)40 (27.6)42 (29.8)
Lesion size, mm (SD)29.3 ± 18.030.1 ± 18.125.9 ± 17.429.8 ± 18.70.182

Biopsy characteristics overall and for the three enhancement groups_ A Chi-square test was performed to test for differences between the groups_ Significance is indicated in bold

CharacteristicOverallUnenhanced biopsyLipiodol-enhancedi.v. contrast-enhancedp-value
Biopsy access path0.718
  Lateral-intercostal335 (55.2)162 (50.5)94 (64.8)79 (56.0)
  Anterior-subcostal224 (36.9)25 (7.8)9 (6.2)10 (7.1)
  Anterior-lateral44 (7.2)132 (41.1)42 (29.0)50 (35.5)
  Dorsal-lateral4 (0.7)2 (0.6)02 (1.4)
Segment localization0.052
  16 (1.0)2 (0.6)2 (1.4)2 (1.4)
  254 (8.9)29 (9.0)14 (9.7)11 (7.8)
  341 (6.8)23 (7.2)8 (5.5)10 (7.1)
  4112 (18.5)66 (20.6)23 (15.9)23 (16.3)
  595 (15.7)57 (17.8)21 (14.5)17 (12.1)
  6112 (18.5)69 (21.5)21 (14.5)22 (15.6)
  782 (13.5)31 (9.7)22 (15.2)29 (20.6)
  8105 (17.3)44 (13.7)34 (23.4)27 (19.1)
Access path length [mm] (SD)
  Cutis to lesion83 ±2682 ±2785 ±2783 ±260.527
  Liver capsule to lesion43 ±2644 ±2141 ±2143 ±210.473
Obtained probes (SD)2.6 ±1.32.7 ±1.52.5 ±0.92.4 ±0.90.158
Radiation exposure (SD)
  Whole examination [mGycm2]498.3 ±429.5361.0 ±166.6411.3 ±517.9900.3 ±495.60.019
  Biopsy scans [mGycm2]80.1 ±58.079.7 ±60.088.2 ±56.372.6 ±56.40.053
  Intervention (i)-images [n]34.4 ±24.034.6 ±23.837.7 ±23.430.6 ±24.70.182
Complications0.870
  Sub-capsular liver bleeding3 (0.5)1 (0.3)1 (0.7)1 (0.7)
  Fluid edge around liver2 (0.3)1 (0.3)01 (0.7)
  Bleeding along the access path1 (0.2)01 (0.7)0
  Circulatory problems1 (0.2)1 (0.3)00
DOI: https://doi.org/10.2478/raon-2023-0024 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 158 - 167
Submitted on: Feb 17, 2023
Accepted on: Apr 20, 2023
Published on: Jun 21, 2023
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year

© 2023 Marcel Christian Langenbach, Thomas Joseph Vogl, Amelie Buchinger, Katrin Eichler, Jan-Erik Scholtz, Renate Hammerstingl, Tatjana Gruber-Rouh, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.