Stattaus Joerg, Kuehl Hilmar, Ladd Susanne, Schroeder Tobias, Antoch Gerald, Baba Hideo A, Barkhausen Joerg, Forsting Michael
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):928-35. doi: 10.1007/s00270-007-9023-8.
Our study aimed to determine the visibility of small liver lesions during CT-guided biopsy and to assess the influence of lesion visibility on biopsy results.
Fifty patients underwent CT-guided core biopsy of small focal liver lesions (maximum diameter, 3 cm); 38 biopsies were performed using noncontrast CT, and the remaining 12 were contrast-enhanced. Visibility of all lesions was graded on a 4-point-scale (0 = not visible, 1 = poorly visible, 2 = sufficiently visible, 3 = excellently visible) before and during biopsy (with the needle placed adjacent to and within the target lesion).
Forty-three biopsies (86%) yielded diagnostic results, and seven biopsies were false-negative. In noncontrast biopsies, the rate of insufficiently visualized lesions (grades 0-1) increased significantly during the procedure, from 10.5% to 44.7%, due to needle artifacts. This resulted in more (17.6%) false-negative biopsy results compared to lesions with good visualization (4.8%), although this difference lacks statistical significance. Visualization impairment appeared more often with an intercostal or subcostal vs. an epigastric access and with a subcapsular vs. a central lesion location, respectively. With contrast-enhanced biopsy the visibility of hepatic lesions was only temporarily improved, with a risk of complete obscuration in the late phase.
In conclusion, visibility of small liver lesions diminished significantly during CT-guided biopsy due to needle artifacts, with a fourfold increased rate of insufficiently visualized lesions and of false-negative histological results. Contrast enhancement did not reveal better results.
我们的研究旨在确定CT引导下肝活检时小肝病灶的可视性，并评估病灶可视性对活检结果的影响。
50例患者接受了CT引导下小局灶性肝病灶（最大直径3 cm）的芯针活检；38例活检采用非增强CT进行，其余12例采用增强CT。在活检前和活检过程中（将针置于目标病灶附近及病灶内），所有病灶的可视性按4级标准分级（0级=不可见，1级=可见性差，2级=可见性充分，3级=可见性极佳）。
43例活检（86%）获得诊断结果，7例活检为假阴性。在非增强活检中，由于针伪影，术中可视性不足的病灶（0 - 1级）发生率从10.5%显著增加至44.7%。与可视性良好的病灶相比，这导致更多（17.6%）的活检结果为假阴性（4.8%），尽管这种差异缺乏统计学意义。分别在肋间或肋下进针与上腹部进针以及在包膜下病灶与中央病灶定位时，可视性受损更常出现。增强活检时肝病灶的可视性仅暂时改善，晚期有完全模糊的风险。
总之，在CT引导下肝活检过程中，由于针伪影，小肝病灶的可视性显著降低，可视性不足的病灶和组织学假阴性结果的发生率增加了四倍。增强检查并未显示出更好的结果。
