Liver Biopsy and Pressure Hemodynamics: IR Perspective

Abstract Liver biopsy is important for staging of liver disease and cirrhosis and can be performed by many techniques. While percutaneous biopsy is fast, safe, effective, and widely available, transvenous biopsy, most often performed from the transjugular approach, offers many advantages for selected patients. In the setting of suspected or confirmed portal hypertension, transjugular liver biopsy (TJLB), most commonly performed by interventional radiologists, can be used to simultaneously obtain core biopsies of the liver and measure hemodynamic pressures in the right atrium, hepatic vein, and portal vein to calculate a hepatic venous pressure gradient. TJLB can be performed safely when percutaneous biopsy is contraindicated, including in the setting of ascites, coagulopathy, anticoagulation, and other high-risk bleeding situations. The procedure can be performed in the outpatient setting in a short period of time for most patients and without the use of precious anesthesia resources. Hepatic venography also allows for variant anatomy evaluation that may be important in the diagnosis and planning of future procedures, such as transjugular intrahepatic portosystemic shunt.