A liver biopsy can be a vital resource for diagnosing, assessing, and treating a variety of liver diseases and conditions. A liver biopsy is conducted by taking a sample of liver tissue by way of a needle that is then taken to a laboratory for testing. This can be performed in a variety of ways. The gold standard for liver biopsies is performing them under image guidance. The two most common imaging modalities used are ultrasound and computed tomography (CT). Within each of these modalities, liver biopsies can be performed in multiple ways. CT-guided biopsies can be performed unenhanced, intravenous (IV) enhanced, and intra-arterial Lipiodol-marked enhanced. Ultrasound biopsies can be performed percutaneously with either no contrast or with contrast and can also be performed endoscopically (EUS). When a liver biopsy is performed it is either targeted or random. Indications for a targeted liver biopsy include to differentiate between benign and malignant, primary or secondary malignancy, or to diagnose or stage metastatic disease. Random liver biopsy indications include acute injury, chronic parenchymal disease, transplant rejection, and abnormal liver function tests. Risks associated with liver biopsies include pain, bleeding, injury to other structures, allergic reactions, bile leaks, and death. Using ultrasound is considered the gold standard for image guided liver biopsies, but in some cases CT guidance should be used. These instances include when lesions are not adequately visualized on ultrasound or when a safe needle trajectory can’t be identified with ultrasound. This research aims to compare the use of ultrasound and CT for image guided liver biopsies and the different types used for each, as well as understanding the safety of image guided liver biopsies and emerging technology. Continued research should be conducted involving endoscopic ultrasound guided liver biopsies and contrast use in image guided biopsies to understand their significance.
