title: Color ultrasound-guided fine needle cutting biopsy for the characterization of diffuse liver damage in critical bone marrow transplanted patients.
abstract: OBJECTIVE
  The optimal method for liver biopsy in patients with simultaneous bone marrow and liver impairment has not yet been established. New approaches (e.g. imaging-guided methods) for this procedure are needed. In spite of coagulopathy, immunosuppression, anemia or ascites, we histologically characterized liver damage in a series of bone marrow transplanted patients using color-Doppler ultrasonography, which permits very keen visualization (and assessment) of hepatic parenchyma and vessels, and a fine needle for percutaneous biopsy.
  
  
  METHODS
  We performed percutaneous liver biopsy using a Menghini-type automatic very fine cutting needle (1.2 mm, 18G) under color ultrasound guidance in 16 bone marrow transplanted adult patients consecutively seen in our units from 1998 to 2001. The patients had clinically defined diffuse serious liver damage; liver biopsy was performed between 3 and 10 months after allogeneic (n= 11) or autologous (n= 5) transplantation.
  
  
  RESULTS
  Fifteen patients tolerated the procedure well and had no discomfort, while one patient developed intrahepatic hemorrhage. All liver biopsies were suitable for histologic examination and informative, revealing the specific etiology of liver damage: graft-versus-host disease in six patients, drug toxicity in five, hepatitis C virus acute reactivation in two, and in one each vanishing bile duct syndrome, nodular regenerative hyperplasia and hemochromatosis. Biopsy detected potentially injurious concomitant factors, e.g., occult intrahepatic hepatitis B virus infection and reactivation. Histology radically changed the presumptive clinical diagnosis in 10 of the 16 patients and led to successful treatment changes in six.
  
  
  CONCLUSIONS
  Percutaneous biopsy with a small cutting needle under color ultrasound guidance carries a low risk of complications and provides reliable information regarding liver histology in critically ill patients, in the early stage after bone marrow transplantation. We suggest including this imaging-guided mini-invasive procedure to the standard work-up of post-transplant liver damage.
authors.affiliation: Division of Hematology, Federico II University Medical School, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Picardi
authors.forename: Pietro
authors.initials: P
authors.lastname: Muretto
authors.forename: Gennaro
authors.initials: G
authors.lastname: De Rosa
authors.forename: Carmine
authors.initials: C
authors.lastname: Selleri
authors.forename: Amalia
authors.initials: A
authors.lastname: De Renzo
authors.forename: Marcello
authors.initials: M
authors.lastname: Persico
authors.forename: Bruno
authors.initials: B
authors.lastname: Rotoli
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color