Gastrointestinal Imaging
Transcutaneous Management of Bleeding after Solid Organ Biopsy— What the Radiologist Needs to Know and Use
Nami Azar, MD,1 Tal Delman, MD2 and Dean Nakamoto, MD3
1. Fellowship Director, Abdominal Imaging, University Hospitals of Cleveland–Case Medical Center and Assistant Professor, Case Western Reserve University School of Medicine; 2. Radiology Resident, University Hospitals of Cleveland–Case Medical Center; 3. Section Head, Abdominal Imaging, University Hospitals of Cleveland–Case Medical Center and Associate Professor, Case Western Reserve University School of Medicine
Abstract
Image-guided percutaneous biopsy has emerged as a safe and efficient method for establishing tissue diagnosis. Ultrasound-guided biopsy is increasingly being utilized because of its efficacy, realtime monitoring of biopsy, and lack of ionizing radiation. The increasing demands placed on physicians, and radiologists in particular, make maximizing work efficiency a top priority. The main strengths of sonography as an aid to percutaneous intervention are its ease of use, portability, and realtime nature, all of which expedite the planning and execution of procedures. The increasing complexity of medicine makes it necessary for radiologists to adapt to challenging situations. A prime example is the use of co-axial systems to facilitate safer and more accurate diagnosis, particularly in high-risk patients. Co-axial systems also provide accurate access, helping to minimize and manage bleeding-related complications. Finally, local deployment of Gelfoam® or a coil following transcutaneous biopsy is an effective method to prevent and manage acute bleeding, resulting in reduced complication rates and a reduced need for transfusions and subsequent hospital admission.
Keywords Ultrasound-guided, Gelfoam, co-axial, percutaneous biopsy, bleeding, coil, thrombin
Disclosure: Nami Azar, MD, and Dean Nakamoto, MD, are employees of Toshiba Imaging Systems. Tal Delman, MD, has no conflicts of interest to declare. Received: July 12, 2010 Accepted: September 9, 2010 Citation: US Radiology, 2011;3:53–6 Correspondence: Tal Delman, MD, University Hospitals of Cleveland–Case Medical Center, Department of Radiology, 11100 Euclid Ave, Cleveland, OH 44106. E:
Tal.Delman@
UHhospitals.org
The remarkable advances in radiologic imaging over the past two decades have led to enhanced methods of disease evaluation, enabling both earlier detection and more accurate assessment of the extent of involvement. Increased sensitivity and specificity of lesion detection on imaging has resulted in greater dependence on pathologic diagnosis, ultimately allowing for optimally tailored therapies. In this respect, imaging-guided intervention has emerged as a safe and accurate method of obtaining tissue diagnosis with a lower incidence of complications, decreased morbidity and mortality, and improved efficiency.1,2
The shift toward minimally invasive medicine remains steady, resulting in increased dependence on percutaneous imaging-guided interventions such as biopsy and ablation. This trend may be largely attributed to the marked increase in incidental lesions identified on screening examinations and other routine imaging studies.3
It also reflects a rise in the number of renal
and liver transplants performed and an increased incidence of infectious hepatitis cases.4
of focal or diffuse liver or kidney disease.3
Other indications include definitive characterization Percutaneous biopsy has
demonstrated decreased morbidity and mortality compared with open surgical or laparoscopic approaches.2
decrease the length of hospital stay following a procedure and have © TOUCH BRIEFINGS 2011 Imaging-guided biopsies greatly
yielded improved time and cost-efficiency.2,5
Finally, minimally invasive
biopsy plays an important role in monitoring response to therapy as well as grading and staging of chronic viral hepatitis.4
Ultrasound is particularly useful in guiding percutaneous interventions given the absence of ionizing radiation, the ability to perform biopsies in realtime, and its portable bedside capability. It enables accurate assessment of solid organs in the abdomen and pelvis without the risks associated with intravenous contrast administration. Doppler imaging can be used to characterize the degree of hyperemia within a lesion and can aid in planning a safe approach, as well as in monitoring for bleeding-related complications following the procedure.4
It is especially
favored in procedures involving pregnant patients and young children given their higher sensitivity to ionizing radiation (see Figure 1). Ultrasound markedly reduces procedure length and has dramatically improved cost-effectiveness compared with guidance provided by other cross-sectional imaging modalities.5
Ultrasound-guided percutaneous biopsy is operator-dependent; as a result, complications are often directly linked to the extent of the radiologist’s experience.2
While the risk of superficial infection and sepsis, 53
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