Usefulness of contrast enhanced ultrasound guidance in percutaneous biopsies of liver tumors.

The performance of percutaneous echoguided biopsy in hepatic tumor diagnosis is limited by several factors, among which tumor characteristics such as tumor type, size and location play an important role. With all the advantages offered by ultrasound guidance, the overall sensitivity of this method in the tumor diagnosis has remained around 90%. Contrast enhanced ultrasound (CEUS) guided percutaneous biopsy is a new developed technique aimed at increasing the accuracy of percutaneous biopsies. With new ultrasound devices comprising the split-screen mode, which displays both the CEUS and background B-mode US image simultaneously on a single monitor, the procedure is now technically feasible. CEUS guided percutaneous liver biopsy should be applied in large tumors with consistent necrosis, in hypovascular tumors or in those invisible or poorly visible to conventional ultrasound. An increased accuracy was demonstrated in poorly visible or invisible hepatic lesions and when CEUS was used before biopsy.