Role of CEUS in the diagnosis of gallbladder disease

Conventional ultrasound (US) is the first imaging investigation recommended for diagnosis of gallbladder pathology. However, it has an important limit of ability to depict microcirculation of some biliary lesions which may lead to failure in diagnosis. The use of contrast-enhanced US (CEUS) seems to overcome these limits and allows a more confident diagnosis. In this review, the methodology, image interpretation, enhancement pattern, clinical usefulness, and indications for CEUS in gallbladder lesions are summarized. CEUS may be indicated under the following circumstances: 1) For differentiation diagnosis between a malign tumor or a benign tumor of the gallbladder; 2) to make a distinction between motionless sludge and gallbladder carcinoma; 3) to assess the extension of gallbladder carcinoma in adjacent hepatic parenchyma; 4) patients with impaired renal function.