A Practical Approach to Performing a Contrast-Enhanced Ultrasound-Guided Percutaneous Liver Biopsy

Introduction: Contrast-enhanced ultrasonography (CEUS) is a complementary technique in which microbubble contrast agents are utilized in conjunction with tissue harmonic imaging to depict blood flow and tissue perfusion. There are potential advantages to the selective use of contrast enhancement for ultrasound-guided interventions. Lesions of interest detected by computed tomography (CT) or magnetic resonance imaging (MRI) may be occult on traditional B-mode ultrasound. Furthermore, it may be difficult to differentiate viable tumor tissue from necrotic tissue, and thus difficult to target that part of a lesion yielding viable tumor cells. CEUS cannot only improve the localization of lesions for biopsy but also increase diagnostic yield through identification and avoidance of necrotic tissue. Given its advantages, CEUS can be a valuable adjunct technique to improve technical success and diagnostic yield of tissue biopsies.

Content Organization: We will present cases where hepatic lesions visualized on CT and MRI were occult on traditional B-mode ultrasound but were visualized when ultrasound contrast agents were utilized. We will demonstrate how ultrasound contrast agents can depict intralesional regions of tissue necrosis, which when avoided can potentially improve biopsy yield. Additionally, we will cover the imaging technique behind tissue harmonic imaging and the role that ultrasound contrast agents play.

Learning Points: Understand potential indications for CEUS, with several case examples demonstrating the value of the modality in improving technical success and diagnostic yield of liver biopsies. Understand the technique to performing a successful CEUS-guided biopsy.