E1451. Percutaneous Versus Transjugular Liver Biopsy: Indications, Techniques, Adequacy, and Complications
Both transjugular and percutaneous liver biopsies are accepted methods of obtaining tissues samples for diagnosing liver disease. Although transjugular liver biopsy is limited with regard to targeted liver biopsy, both transjugular and percutaneous liver biopsy have been shown to effectively obtain liver tissue for diffuse liver pathology.Traditionally, transjugular liver biopsy has been reserved for patients with contraindications to percutaneous liver biopsy; typically due to coagulopathy or presence of ascites. However, in studies that have compared the two techniques, there are decreased rates of complications and decreased rates of complications requiring intervention in the transjugular biopsy cohort. Therefore the purpose of this exhibit is to illustrate the differences in current indications, techniques, tissue sample adequacy, and complications of transjugular and percutaneous liver biopsy in order to provoke thoughts by interventional radiologists as to which technique is truly best for their patients, which perhaps is different that classical beliefs.
Educational Goals / Teaching Points
1) To discuss the indications for percutaneous and transjugular liver biopsy.
2) To describe the techniques for both percutaneous and transjugular liver biopsy.
3) To discuss adequacy of tissue samples obtained in both percutaneous and transjugular liver biopsy.
4) To discuss complications of percutaneous and transjugular liver biopsy including those that require interventions.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Currently, the two main factors in decided whether or not to perform a percutaneous liver biopsy versus transjugular liver biopsy is the patient's coagulation profile and presence of ascites. Classically, patient's who are coagulopathic or have ascites have a transjugular liver biopsy as with this technique, if any bleeding occurs (assuming the capsule of the liver isn't perforated when obtaining the sample), the bleeding will occur straight into the hepatic vein and resolve on it's own. Conversely, if a patient bleeds after a percutaneous liver biopsy, in which the capsule is always violated, the patient can develop subcapsular and/or intraperitoneal hemorrhage. However, even in patient's with normal coagulation profile, there is a risk of bleeding. Therefore, perhaps more thought should be given to more liberal use of transjugular liver biopsies to prevent the most feared complication of liver biopsy, which is bleeding. This exhibit will also examine other complications of both techniques.
Both percutaneous and transjugular liver biopsies are safe and effective ways of obtaining liver tissue for diagnosis. Overall tissue adequacy for diagnosis is similar between the two groups. The main factor in deciding between the two techniques is the patient's coagulation status and perhaps overall, there should be more transjugular liver biopsies performed to minimize the most feared complication of liver biopsy, which is bleeding.