Using multimodal ultrasound technology to improve the success rate of liver tumor puncture for lesions with poor visibility on conventional ultrasound imaging

Background: The ability of conventional ultrasound (US)-guided liver biopsy to visualize certain liver lesions, particularly those affected by conditions like hepatitis or cirrhosis, which can obscure lesion boundaries and lead to inaccurate biopsy targeting, is limited. This study aimed to evaluate the potential of multimodal US techniques to improve the visibility of liver lesions that are indistinct under conventional US, and to enhance the success rate of percutaneous biopsies.

Methods: In total, 144 patients with liver masses and lesions that were not clearly visible on conventional US from October 2018 to January 2024 were enrolled in this retrospective analysis. The lesions of these patients exhibited poor visibility on conventional US, but the tumor location was visible on abdominal computerized tomography (CT) or magnetic resonance (MR) imaging scans. After excluding patients who did not undergo biopsy or patients with lesions that were remained not clearly visible on multimodal US examinations. Ultimately, a total of 95 patients were enrolled in this study. We analyzed the clinical and imaging data for all these patients. CT/MR-US fusion imaging was performed in 55 patients, contrast-enhanced ultrasound (CEUS) was performed in 95 patients, and high-frequency US was performed in 21 patients. The visibility of the lesions using these three techniques was evaluated, and the consistency between the biopsy pathology and the final diagnosis was analyzed.

Results: In the study, the detection rates of lesions using CT/MR-US fusion imaging, CEUS, and high-frequency US were 49.1%, 96.8%, and 76.2%, respectively. After confirming the target location of the lesions, all patients underwent percutaneous US-guided biopsy. The accuracy rate of the biopsies was 91.6%, and the positive concordance rate was 91.1%. Among the 13 patients with negative pathology findings after biopsy, 8 had false-negative results (based on follow-up laboratory tests and imaging results consistent with malignant tumor characteristics), resulting in a false-negative rate of 8.9%.

Conclusions: Multimodal US significantly improved the success of biopsies for liver lesions not clearly visible on conventional US, aiding in precise treatment planning.