Clinical benefits of MRI-guided freehand biopsy of small focal liver lesions in comparison to CT guidance

Abstract Objectives To compare clinical success, procedure time, and complication rates between MRI-guided and CT-guided real-time biopsies of small focal liver lesions (FLL) < 20 mm. Methods A comparison of a prospectively collected MRI-guided cohort ( n = 30) to a retrospectively collected CT-guided cohort ( n = 147) was performed, in which patients underwent real-time biopsies of small FLL < 20 mm in a freehand technique. In both groups, clinical and periprocedural data, including clinical success, procedure time, and complication rates (classified according to CIRSE guidelines), were analyzed. Wilcoxon rank sum test, Pearson’s chi-squared test, and Fisher’s exact test were used for statistical analysis. Additionally, propensity score matching (PSM) was performed using the following criteria for direct matching: age, gender, presence of liver cirrhosis, liver lobe, lesion diameter, and skin-to-target distance. Results The median FLL diameter in the MRI-guided cohort was significantly smaller compared to CT guidance ( p < 0.001; 11.0 mm vs. 16.3 mm), while the skin-to-target distance was significantly longer ( p < 0.001; 90.0 mm vs. 74.0 mm). MRI-guided procedures revealed significantly higher clinical success compared to CT guidance ( p = 0.021; 97% vs. 79%) as well as lower complication rates ( p = 0.047; 0% vs. 13%). Total procedure time was significantly longer in the MRI-guided cohort ( p < 0.001; 38 min vs. 28 min). After PSM ( n = 24/ n = 38), MRI-guided procedures still revealed significantly higher clinical success compared to CT guidance ( p = 0.039; 96% vs. 74%). Conclusion Despite the longer procedure time, freehand biopsy of small FLL < 20 mm under MR guidance can be considered superior to CT guidance because of its high clinical success and low complication rates. Clinical relevance statement Biopsy of small liver lesions is challenging due to the size and conspicuity of the lesions on native images. MRI offers higher soft tissue contrast, which translates into a higher success of obtaining enough tissue material with MRI compared to CT-guided biopsies. Key Points • Image-guided biopsy of small focal liver lesions (FLL) is challenging due to inadequate visualization, leading to sampling errors and false-negative biopsies . • MRI-guided real-time biopsy of FLL < 20 mm revealed significantly higher clinical success (p = 0.021; 97% vs. 79%) and lower complication rates (p = 0.047; 0% vs. 13%) compared to CT guidance. • Although the procedure time is longer, MRI-guided biopsy can be considered superior for small FLL < 20 mm. Graphical Abstract