To investigate the clinical application value of intra-biliary contrast-enhanced ultrasound (IB-CEUS).

Ten patients with ampullary obstruction in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2011 were enrolled in this prospective study. There were 6 males and 4 females with age ranging from 30 to 83 years old and a median age of 57 years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients underwent percutaneous transhepatic cholangial drainage (PTCD) firstly and then received IB-CEUS and X-ray cholangiography. The visualization effects of drainage tubes, gall bladders, intestines, extrahepatic bile ducts and all orders of intrahepatic bile ducts by IB-CEUS and X-ray cholangiography were observed. The visualization rates of two methods were compared by Fisher′s exact probability test. The highest orders of intrahepatic biliary branches that could be visualized were compared by rank sum test.

The biliary tree structure could be visualized both by two examination methods. The visualization rates of drainage tubes, gall bladders, intestines and extrahepatic bile ducts were 100%, 78%, 30%, 100% by IB-CEUS, and were 100%, 89%, 40%, 100% by X-ray cholangiography respectively, where no significant difference was observed (P>0.05). The visualization rates of first-, second-, third-order intrahepatic biliary branch number by IB-CEUS were 100%, 98%, 98% and were 100%, 100%, 100% by X-ray cholangiography respectively, where no significant difference was observed (P>0.05). The highest order of intrahepatic biliary branches that could be visualized was 3.5(3.0-5.0) by IB-CEUS, and was 4.5(4.0-5.0) by X-ray cholangiography, where significant difference was observed (Z=-3.000, P<0.05).

IB-CEUS is an important intra-biliary imaging modality with similar visualization effects as X-ray cholangiography, which could be an important substitutional method of the X-ray cholangiography.