Optimizing modality selection for image-guided procedures: an analysis of the challenges to ultrasound guidance

• Published in: Abdominal imaging 2016-04, Vol.41 (4), p.590-599
• Main Authors: Beland, Michael D., Sternick, Laura A., Baird, Grayson L., Dupuy, Damian E., Cronan, John J., Mayo-Smith, William W.
• Format: Article
• Language: English
• Subjects: Ablation Techniques; Adult; Aged; Contrast Media; Decision Making; Drainage; Female; Gastroenterology; Hepatology; Humans; Image-Guided Biopsy; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Radiography, Interventional; Radiology; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-016-0637-7

Introduction Selection of the most appropriate modality for image guidance is essential for procedural success. We identified specific factors contributing to failure of ultrasound-guided procedures that were subsequently performed using CT guidance. Materials and methods This single-center, retrospective study included 164 patients who underwent a CT-guided biopsy, aspiration/drainage, or ablation after initially having the same procedure attempted unsuccessfully with ultrasound guidance. Review of the procedure images, reports, biopsy results, and clinical follow-up was performed and the reasons for inability to perform the procedure with ultrasound guidance were recorded. Patient cross-sectional area and depth to target were calculated. Differences in area and depth were compared using general linear modeling. Depth as a predictor of an unfavorable body habitus designation was modeled using logistic regression. Results US guidance was successful in the vast majority of cases (97%). Of the 164 procedures, there were 92 (56%) biopsies, 63 (38%) aspirations/drainages, and 9 (5%) ablations. The most common reason for procedure failure was poor acoustic window (83/164, 51%). Other reasons included target lesion being poorly discerned from adjacent tissue (61/164, 37%), adjacent bowel gas (34/164, 21%), body habitus (27/164, 16%), and gas-containing collection (22/164, 13%). Within the biopsy subgroup, patients for whom body habitus was a limiting factor were found to have on average a larger cross-sectional area and lesion depth relative to patients whose body habitus was not a complicating factor ( p