From the Guidelines
Ultrasound guidance is the preferred method for liver biopsies due to its real-time visualization, lack of radiation exposure, and lower cost, as supported by the most recent and highest quality study 1. The use of ultrasound guidance has been shown to reduce complications and improve diagnostic yield in liver biopsies, making it the standard first-line approach for routine liver biopsies. Some of the key advantages of ultrasound guidance include:
- Real-time visualization during needle insertion, allowing for accurate targeting of lesions and avoidance of blood vessels and other structures
- No radiation exposure, making it a safer option for patients
- Lower cost and wider availability compared to CT guidance
- Ability to perform the procedure at the bedside, making it more convenient for patients and healthcare providers CT guidance is typically reserved for specific situations where ultrasound visualization is inadequate, such as in very obese patients, when lesions are difficult to visualize on ultrasound, or when the target is near critical structures that are better delineated by CT. However, the most recent study 1 confirms that ultrasound guidance significantly reduces the number of complications when used to guide double-pass liver biopsy compared to the traditional Menghini technique, and also reduces pain and bleeding episodes in percutaneous liver biopsy. The choice between ultrasound and CT should ultimately be based on lesion characteristics, patient factors, institutional expertise, and equipment availability, but for routine liver biopsies, ultrasound guidance represents the standard first-line approach due to its practical advantages and safety profile 1.
From the Research
Liver Biopsy Guidance
The choice between ultrasound and computed tomography (CT) guidance for liver biopsies depends on various factors, including the specific clinical scenario and the availability of resources.
- Ultrasound Guidance: Ultrasound-guided liver biopsy is a commonly used technique, especially for patients with diffuse liver disease 2. A study comparing real-time ultrasound guidance with marking the puncture site before biopsy found no significant differences in diagnostic yield or complication rates 2. However, another study suggested that contrast-enhanced ultrasound guidance can improve the sensitivity of liver biopsies, especially for large or poorly visualized lesions 3.
- CT Guidance: CT guidance is also used for liver biopsies, particularly in cases where ultrasound guidance is not feasible or when the lesion is not well-visualized on ultrasound 4. A study comparing CT-guided and sonography-guided biopsies in patients with ascites found no significant difference in complication rates between the two groups 4.
- Contrast-Enhanced Ultrasound Guidance: Contrast-enhanced ultrasound guidance has been shown to be a feasible and safe technique for liver biopsies, especially for lesions that are not confidently localized on B-mode ultrasound 5. This technique can improve the sensitivity of biopsies and reduce the number of complications 3, 5.
- Comparison of Guidance Techniques: The choice of guidance technique depends on the specific clinical scenario and the availability of resources. While ultrasound guidance is commonly used, CT guidance may be preferred in certain cases, such as when the lesion is not well-visualized on ultrasound. Contrast-enhanced ultrasound guidance is a promising technique that can improve the sensitivity and safety of liver biopsies 3, 5.
Key Findings
- Ultrasound guidance is a commonly used technique for liver biopsies, but may not always be superior to CT guidance 2, 4.
- Contrast-enhanced ultrasound guidance can improve the sensitivity and safety of liver biopsies, especially for large or poorly visualized lesions 3, 5.
- The choice of guidance technique depends on the specific clinical scenario and the availability of resources 2, 3, 4, 5.