Three dimensional ultrasound guided biopsy of the liver and pancreas

Background: In case of fine-needle biopsy of liver and pancreas tumors the two-dimensional and color-Doppler ultrasound has no possibility to give an exact localization of the peritumoral portal, hepatic and peripancreatic vasculature. Digital technique has a new era in the three-dimensional ultrasound /3D/ diagnostics, which makes possible the immediate spatial reconstruction of the opened investigation area. In case of parenchymal tumors we used the three-orthogonal-plane volumetry method. We searched for malignant vasculature and signs of dislocation and compression by color- and power-Doppler examination. Patients and method: Patients with primary and metastatic liver and pancreas tumors were examined before, at- and after the biopsy. The intrahepatic portal and hepatic venous vasculature with the direction of the circulation was evaluated by 3D color-Doppler sonography. The 3D reconstruction of the liver hilum with the spatial anatomic variations of vessels has been determined. The patients were followed up after the procedure.

Results: The prebiopsy assessment of patients by 3D ultrasound could demonstrate all the peritumoral vessels visualized partly by 2D color-Doppler US. 3D reconstruction of the tumors and the investigation time proved to be shorter than the previous non-digital techniques. After using the new cut-mode, the vascularization of the liver and pancreas parenchyma became more visible.

Conclusion: Digital 3D ultrasound

examination of patients at fine-needle biopsy in cases of different liver and pancreas tumors gives new information of the anatomic situation of peritumoral vessels and portal thrombosis. The follow-up of patients after the biopsy may be the most valuable non-invasive method of choice.