Liver biopsy and thermal ablation of liver tumors are well-established procedures, typically performed under CT or ultrasound (US) guidance. However, small tumors are barely visible (especially on CT imaging), and unfavorable localizations for CT and US guidance (e.g., in the liver dome) increase the risk of sampling errors or incomplete ablation. For liver tumors < 3 cm in size, a sampling error of around 20% has been published. Furthermore, biopsy under CT guidance bears the risk of X-ray exposure, especially for the interventional radiologist. MRI provides a high soft tissue contrast that can even be enhanced for a prolonged period with hepatocyte-specific contrast agents. This enables better visualization of liver tumors than with CT or US imaging, where contrast enhancement is limited to a short period of time during the contrast agent administration. Furthermore, the slice orientation can be chosen freely in MRI. This allows a slice orientation along the needle trajectory, displaying needle and target within the slice regardless of the complexity of the angulation. MRI can be performed as fluoroscopic imaging with a fast frame rate of less than one second per image. Even an alternating display of the needle path in perpendicular projections is possible. As a consequence, small lesions and oblique needle access do not represent a limitation for biopsy or ablation under MRI guidance. With regard to liver biopsies, clinical success rates of around 90% for MRI-guided biopsies were described in some early studies, and, in some smaller case series, they were even higher (> 90%). Shoutout and thank you to the co-authors: Matthias Fabritius, M.D. and Jens Ricke, M.D.

MRI-Guided vs. CT-Guided Interventions: A Focus on the Liver by Max Seidensticker, M.D.; et al. (@lmuradiology.bsky.social, Munich, Germany).
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