Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
University of Toronto, Toronto, ON, Canada.
Pediatr Radiol. 2020 Nov;50(12):1717-1723. doi: 10.1007/s00247-020-04783-1. Epub 2020 Aug 13.
Surveillance post image-guided percutaneous liver biopsy in children is variable.
The aim of this study was to assess the value of 4-6-h post-procedure ultrasonography (US) in detecting post-liver-biopsy hemorrhage.
This prospective study included pediatric patients who underwent US-guided percutaneous liver biopsies. All children had a US study obtained pre-procedure and one obtained 4-6 h post-procedure; US examinations were deemed positive if abnormalities were present. We also reviewed any subsequent imaging that was performed within 7 days (late imaging) at the discretion of the referring team. Changes in US findings (ΔUS) were graded by two radiologists using a descriptive non-validated scale (none, minimal, marked). Hemoglobin (Hb) levels were assessed pre-procedure and 4 h post-procedure. The diagnostic accuracy of US changes for detecting post-procedural hemorrhage was calculated based on a drop in Hb >1.5 g/dL or Hb >15% from baseline (ΔHb). We used a Kruskal-Wallis test to correlate the ΔHb with ΔUS. Association between late-imaging and post-procedure US findings was tested using a chi-square test. We included 224 biopsies.
The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post-procedure US in detecting post-procedure hemorrhage ranged 26.3-42.1%, 72.4-93.3%, 0.22-0.42, and 0.87-0.88, respectively. No significant association was seen between the ΔHb and sonographic findings (P=0.068). No significant difference was seen in the need for late imaging between children who did and those who did not have positive US findings (P=0.814).
The sensitivity and PPV of post-procedure US in detecting post-procedural hemorrhage are low. Our findings do not support routine post-procedure surveillance US.
儿童经皮肝活检术后的监测影像结果存在差异。
本研究旨在评估术后 4-6 小时超声（US）检查在发现肝活检术后出血中的价值。
本前瞻性研究纳入了接受 US 引导下经皮肝活检的儿科患者。所有患者均进行术前和术后 4-6 小时的 US 检查；若存在异常，则认为 US 检查结果为阳性。我们还回顾了在参考团队决定下的 7 天内（延迟影像）进行的任何后续影像学检查。两名放射科医生使用描述性非验证性量表（无、轻度、显著）对 US 检查结果的变化（ΔUS）进行分级。评估术前和术后 4 小时的血红蛋白（Hb）水平。根据术后 Hb 下降>1.5 g/dL 或基线值下降>15%（ΔHb），计算 US 变化对检测术后出血的诊断准确性。我们使用 Kruskal-Wallis 检验来关联ΔHb 和 ΔUS。使用卡方检验来检验晚期影像学检查和术后 US 检查结果之间的关系。共纳入 224 例活检。
术后 US 检测术后出血的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 26.3%-42.1%、72.4%-93.3%、0.22-0.42 和 0.87-0.88。ΔHb 与超声表现之间未见显著相关性（P=0.068）。在 US 检查结果为阳性和阴性的患者之间，对是否需要进行晚期影像学检查的需求无显著差异（P=0.814）。
术后 US 检测术后出血的敏感性和 PPV 较低。我们的研究结果不支持常规进行术后监测性 US 检查。
