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Objective: To evaluate the feasibility of percutaneous ultrasound cholangiography (PUSC) with a microbubble contrast agent in assessing obstructive bile duct diseases., Methods: PUSC and percutaneous transhepatic cholangiography (PTC) were performed in 58 patients with obstructive jaundice undergoing ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD). The PUSC findings were compared with PTC using the Chi-squared test, Results: The accuracy of PUSC in determining the level of hilar obstruction and extrahepatic obstruction was 100% (26/26) and 93.3% (30/32), while the accuracy of PTC was 100% for both (P = 1.000, P = 0.492, respectively). The accuracy of PUSC in determining the cause of hilar obstruction and extrahepatic obstruction was 92.3% (24/26) and 93.8% (30/32), respectively, while the accuracy of PTC was 84.6% (22/26) (P = 0.675) and 75% (24/34) (P = 0.039), respectively., Conclusion: PUSC is comparable to PTC in depicting the anatomy of the dilated bile duct tree and determining the level of obstruction for patients with obstructive jaundice, hence it expands the capacity of ultrasound in evaluating obstructive bile duct disease and simplifies the procedure of assessing obstructive jaundice. Key Points • Percutaneous ultrasound-guided cholangiography with microbubbles offers a new form of cholangiography • PUSC compares well with PTC in evaluating the dilated biliary tract. • Radiation is avoided and overall costs may be lower.

The assessment of the extent of liver fibrosis is very important for the prognosis and clinical management of chronic liver diseases. Although liver biopsy is the gold standard for the assessment of liver fibrosis, new non-invasive diagnostic methods are urgently needed in clinical work due to certain limitations and complications of biopsy. Noninvasive imaging studies play an important role in the diagnosis of focal liver disease and diffuse liver diseases. Among them, ultrasonography is the first choice for study of the liver in clinical work. With the development of ultrasound contrast agents and contrast specific imaging techniques, contrast-enhanced ultrasound (CEUS) shows good performance and great potential in the evaluation of liver fibrosis. Researchers have tried different kinds of contrast agent and imaging method, such as arrival time of contrast agent in the hepatic vein, and quantitative analysis of the enhancement level of liver parenchyma, to evaluate the degree of liver fibrosis during the past 10 years. This review mainly summarizes the clinical studies concerning the assessment of liver fibrosis using CEUS.