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World J Radiol. Dec 31, 2009; 1(1): 37-44
Published online Dec 31, 2009. doi: 10.4329/wjr.v1.i1.37
Contrast-enhanced ultrasound in the biliary system: Potential uses and indications
Hui-Xiong Xu
Hui-Xiong Xu, Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, The Center of Guangdong Province for the Study of Diagnostic Ultrasound and Interventional Therapy, 58 Zhongshan Road 2, Guangzhou 510080, Guangdong Province, China
Author contributions: Xu HX wrote this paper.
Supported by (in part) Grant No. NCET-06-0723 from the Chinese Ministry of Education and grant 2008-2-10 of Public Welfare Research Special Project from the Chinese Ministry of Health
Correspondence to: Hui-Xiong Xu, MD, PhD, Professor, Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, The Center of Guangdong Province for the Study of Diagnostic Ultrasound and Interventional Therapy, 58 Zhongshan Road 2, Guangzhou 510080, Guangdong Province, China. xuhuixiong@hotmail.com
Telephone: +86-20-87765183 Fax: +86-20-87765183
Received: November 26, 2009
Revised: December 11, 2009
Accepted: December 21, 2009
Published online: December 31, 2009
Abstract

Conventional ultrasound (US) is the first-line imaging investigation for biliary diseases. However, it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases. The use of contrast-enhanced US (CEUS) has reached the field of bile duct disease in recent years and promising results have been achieved. In this review, the methodology, image interpretation, enhancement pattern, clinical usefulness, and indications for CEUS in the biliary system are summarized. CEUS may be indicated in the biliary system under the following circumstances: (1) Where there is a need to make a characterization of intrahepatic cholangiocarcinoma (ICC); (2) For differentiation diagnosis between ICC and other tumors (i.e. hepatocellular carcinoma or liver metastasis) or infectious diseases; (3) For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma; (4) To detect malignant change in Caroli’s disease; (5) To depict the extent of Klatskin’s tumor with greater clarity; (6) To make a distinction between gallbladder cholesterol polyp, adenoma and polypoid cancer; (7) To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer; (8) For differentiation diagnosis between motionless sludge and gallbladder cancer; (9) For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing; and (10) In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube, US contrast agent can be administered to through the tube detect the site of the tube.

Keywords: Contrast-enhanced ultrasound; Bile duct; Gallbladder; Cholangiocarcinoma; Polypoid lesion; Ultrasound contrast agent