Purpose: The aim of the study was to evaluate the usefulness of extravascular contrast enhanced ultrasound (EV-CEUS) in ultrasound (US) guided percutaneous transhepatic cholangiography and drainage (PTCD) and assessing complications.
Patients and methods: 38 patients underwent PTCD due to primary or secondary bile duct obstruction. After the needle and catheter were inserted into the bile duct, the ultrasound contrast agent (UCA) (0.1 ml of SonoVue® in 20 ml saline) was injected to confirm the correct insertion. The site and the degree of the obstruction were identified. Fluoroscopy was performed as the gold standard. The day after PTCD, the UCA was injected again to examine catheter-related complications.
Results: A total of 44 US guided PTCD were performed. EV-CEUS could correctly confirm the needle position and assess the site of obstruction in all patients, and could correctly determine the degree of obstruction in 97.4 % (37/38) of patients. However, EV-CEUS could not reveal the position of the guide-wire. Nevertheless, EV-CEUS could assess catheter-related complication (dislodgement in 3 patients) and fistula between the pleural and peritoneal cavity (1 patient).
Conclusions: EV-CEUS is a new tool for imaging the biliary systems. It can confirm whether the needle and catheter have been inserted in the bile ducts, determine the site and degree of obstruction, determine the cause of obstruction and assess complications in PTCD. However, EV-CEUS could not completely replace fluoroscopy for the PTCD procedures in which an internal-external catheter or a metal stent is needed.
Key words: cholangiography, ultrasound, microbubbles, drainage, bile duct, complication.
