title: CT-guided biopsy of small liver lesions: visibility, artifacts, and corresponding diagnostic accuracy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. joerg.stattaus@uni-due.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Stattaus
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kuehl
authors.forename: Susanne
authors.initials: S
authors.lastname: Ladd
authors.forename: Tobias
authors.initials: T
authors.lastname: Schroeder
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Hideo A
authors.initials: HA
authors.lastname: Baba
authors.forename: Joerg
authors.initials: J
authors.lastname: Barkhausen
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D001707:Biopsy, Needle / Q000379:methods*; D003287:Contrast Media; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide