Tomography Cholangiography Research Articles

Assessment of the biliary branching pattern of the caudate lobe in perihilar cholangiocarcinoma using ENBD-CT cholangiography.

Preoperative recognition of the anatomy of caudate biliary branches is important for the safe and complete resection of perihilar cholangiocarcinoma (PHC). In the present study, we identified these branches using an endoscopic nasobiliary drainage tube (ENBD). Between January 2012 and October 2022, 89 patients with suspected PHC underwent computed tomographic (CT) cholangiography through ENBD and caudate biliary branching patterns were examined. Multidetector raw CT (MDCT) scans on 85 patients with PHC without biliary drainage were also investigated. The caudate biliary branches detected by each modality were evaluated. ENBD-CT cholangiography detected 206 caudate branches (2.44 branches/patient), while MDCT identified 62 branches (0.78 branches/patient). ENBD-CT cholangiography showed that 89 caudate branches drained into the left hepatic duct (LHD), 87 into the posterior hepatic duct (Bpost), and 30 into the right hepatic duct. LHD and Bpost were the common roots of the caudate branches. Some branches (20%) joined the contralateral hepatic duct across the left-right border, but not the anterior hepatic duct or infraportal-type Bpost. ENBD-CT cholangiography clearly showed the caudate biliary branches in patients with PHC after biliary drainage.

Laparoscopic Treatment оf Mirizzi Syndrome

Background. Mirizzi syndrome (MS) is a relatively rare complication of cholelithiasis, which occurs in a wide range from 0.2 to 5% according to different authors. Today, the surgical treatment of MS remains a challenge.Aim of study. To determine the possibilities of laparoscopic interventions in the surgical correction of various types of MS.Material AND methods. The work is based on a prospective analysis of cases of laparoscopic treatment of 19 patients with MS who were treated in the emergency surgery departments of the Republican Scientific Center for Emergency Medical Care in 2017–2019. This is 22.9% of all admitted patients (83) with MS during this period. Type 1 MS was diagnosed in 3 patients (15.7%), type 2 was diagnosed in 16 patients (84.2%).Results. In all cases of type 1 MS, laparoscopic cholecystectomy was performed. A new method for the correction of type 2 MS by forming a sleeve from the gallbladder wall was suggested, which was performed in 10 patients with good results. In the postoperative period, no nonspecific complications were observed in patients undergoing laparoscopic interventions. One patient had residual choledocholithiasis, which was managed by day 5 after the surgery with endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy and the removal of the calculus from the common bile duct. The average duration of stay of patients in a hospital bed was 10.8 days. Fatal outcome was observed in 1 case (5.3%).Conclusion. 1. The inclusion of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and magnetic resonance imaging cholangiography in the diagnostic scheme improves the accuracy and quality of recognition of Mirizzi syndrome and allows the indications for the use of video laparoscopy to be evaluated. 2. Indication for laparocopic treatment of type 2 Mirizzi syndrome is the presence of a single calculus in the supraduodenal part of the common bile duct, which makes it possible to reduce the number of conversion to laparotomy. 3. In cases of type 1 Mirizzi syndrome, the operation of choice is laparoscopic cholecystectomy. 4. The operation of choice in patients with type 2 Mirizzi syndrome is laparoscopic subtotal cholecystectomy, fistula plasty with a gallbladder flap on the Kehr’s T-tube drain with the formation of a “cystic duct”-type sleeve.

The feasibility of medial segment graft in pediatric liver transplantation revisited by three-dimensional printing

BackgroundThe medial segment as a mono-segmental graft was proposed to increase the donor pool for pediatric liver transplantation, but to date, there has been no published case. This study aims to revisit the feasibility of procuring the medial segment graft (MSG) by three-dimensional (3D) printing and ex vivo procedures performed on explanted diseased livers to overcome the gap between theory and clinical implementation. MethodsFrom October 2004 to December 2016, we retrospectively analyzed preoperative computed tomography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography images of our previous live liver donors and identified the indicated anatomy for the MSG, then materialized by 3D printing models to simulate the engraftment. Furthermore, we practiced the procurement procedures on selected explanted diseased livers. ResultsAmong 291 analyzed livers, 96 livers (33%) met the arterial criteria for MSG, and two-thirds of them had ideal portal branches for reconstruction. The proposed right border of the MSG was the Cantlie's line, and the left edge was the right side of the umbilical fissure. The mean estimated volume of the MSG was 234 ± 54 ml. Besides, we suggest implanting the MSG as an auxiliary partial graft in an inverted vertical position or a standalone graft with right-side rotation in the right subphrenic space. ConclusionThe procurement of the MSG is feasible based on our results. However, due to the novelty of the procedure, we suggest that the first attempted case of MSG should be implanted as an auxiliary partial graft to maximize patient safety. Level of EvidenceType of study: Case series with no comparison groups Evidence levelLevel IV.

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma.

Cholangiocarcinoma (CCC) is the most aggressive malignant tumor of the biliary tract. Perihilar CCC (pCCC) is the most common CCC and is burdened by a complicated diagnostic iter and its anatomical location makes surgical approach burden by poor results. Besides its clinical presentation, a multimodal diagnostic approach should be carried on by a tertiary specialized center to avoid miss-diagnosis. Preoperative staging must consider the extent of liver resection to avoid post-surgical hepatic failure. During staging iter, magnetic resonance can obtain satisfactory cholangiographic images, while invasive techniques should be used if bile duct samples are needed. Consistently, to improve diagnostic potential, bile duct drainage is not necessary in jaundice, while it is indicated in refractory cholangitis or when liver hypertrophy is needed. Once resecability criteria are identified, the extent of liver resection is secondary to the longitudinal spread of CCC. While in the past type IV pCCC was not considered resectable, some authors reported good results after their treatment. Conversely, in selected unresectable cases, liver transplantation could be a valuable option. Adjuvant chemotherapy is the standard of care for resected patients, while neoadjuvant approach has growing evidences. If curative resection is not achieved, radiotherapy can be added to chemotherapy. This multistep curative iter must be carried on in specialized centers. Hence, the aim of this review is to highlight the main steps and pitfalls of the diagnostic and therapeutic approach to pCCC with a peculiar attention to type IV pCCC.

Serum negative immunoglobulin G4-associated cholangiopathy mimicking hilar cholangiocarcinoma: A case report and review

Introduction: Immunoglobulin G4-associated cholangiopathy (IAC) is a systemic manifestation of IgG4-related diseases manifesting with an increased serum level of IgG4. Immunoglobulin G4-associated cholangiopathy often has a robust clinical response to steroid therapy, however making a diagnosis can be difficult as the cholangiographic features may resemble that of cholangiocarcinoma with varying immunological profiles. In the absence of features suggestive of malignancy, a high index of suspicion for the disease should be maintained, even in the presence of normal serum levels of IgG4. Case Report: In this case report, the diagnosis of IAC was made following cholangiographic imaging, along with the presence of retroperitoneal fibrosis and thickened urothelia, although serum IgG4 levels were within normal limits. The resolution of biliary strictures following a trial of steroid therapy further confirmed the diagnosis. Conclusion: Immunoglobulin G4-associated cholangiopathy requires a combination of clinical, serological, histopathological, and radiological features in order to make a clear diagnosis. A trial of steroid therapy in the event of an unclear clinical presentation further helps in differentiating IAC from hilar cholangiocarcinoma.

Endosonographic Features of Cholangiocarcinoma and Comparison with Computed Tomography and Endoscopic Retrograde Cholangiography Findings

Endosonographic Features of Cholangiocarcinoma and Comparison with Computed Tomography and Endoscopic Retrograde Cholangiography Findings

Sa1299 HOW CAN ISOLATED PROXIMAL-TYPE IGG4-RELATED SCLEROSING CHOLANGITIS BE DIAGNOSED?

In rare cases, IgG4-related sclerosing cholangitis (IgG4-SC) presents as isolated proximal-type sclerosing cholangitis (i-SC), making diagnosis challenging and resulting in resection in a majority of cases. To clarify the clinical differences between IgG4-SC with and without autoimmune pancreatitis (AIP) and to reveal tips for ruling out malignancy. First, the serum IgG4 level, CA19-9 level, CT findings (nodular lesion), cholangiography findings (apple core appearance; symmetrical smooth long stricture extended upper bile duct), endosonographic features (continuous symmetric mucosal lesion to the hilar part or CSML), endoscopic biopsy results, treatment, relapse, and survival were compared between 9 patients with i-SC and 34 patients with IgG4-SC associated with AIP. Second, the above-mentioned factors were also compared between the i-SC patients and 47 patients with Klatskin tumor. Regarding the differentiation of i-SC and IgG4-SC with AIP, the serum IgG4 level was 338 mg/dL in the i-SC group and 680 mg/dL in the IgG4-SC with AIP group (P < 0.05), and nodular lesions on CT images and an apple core appearance on cholangiography images were significantly more common in the i-SC group (P < 0.01). Endoscopic histopathology specimens from the bile duct were not diagnostic for IgG4-SC. An ampulla biopsy was helpful in the diagnosis of 80% (4/5) of the patients in the i-SC group and 82.3% (14/17) of the patients in the IgG4-SC with AIP group. Resection was performed in 3 patients with i-SC and 3 patients with AIP-SC based on a suspicion of malignancy. Five patients with i-SC underwent a steroid trial. The non-relapse rates were (NRR; i-SC vs. AIP-SC) 100% vs. 79% at 1 year, 100% vs. 53.8% at 3 years, and 66.7% vs. 25.8% at 5 years. The relapse rates were significantly higher in the IgG4-SC with AIP group than in the i-SC group (log rank, P = 0.046). For a differential diagnosis between i-SC and Klatskin tumor, the serum IgG4 level was significantly higher in the i-SC group and the CA19-9 level was higher in the Klatskin tumor group (P < 0.01). The length of the stricture was significantly longer in the Klatskin tumor group (P < 0.01). Complete obstruction was recognized significantly more often in the Klatskin tumor group (P < 0.01). An apple core appearance and CSML were noted significantly more often in the i-SC group (P < 0.01). i-SC presents as a nodular lesion with an apple core appearance mimicking a Klatskin tumor. i-SC exhibits atypical features of IgG4-SC, and serum markers are helpful for differentiating from cancer. A short stricture length without complete obstruction and CSML might be clues for a diagnosis of i-SC. However, once a diagnosis of i-SC has been made, this disease entity is likely to have a more favorable prognosis than IgG4-SC with AIP.

ДІАГНОСТИКА І ЛІКУВАЛЬНІ ТРАНСПАПІЛЯРНІ ВТРУЧАННЯ У ХВОРИХ З ПРИВОДУ ПОРТАЛЬНОЇ БІЛІОПАТІЇ

Проаналізовані результати мініінвазивних ендоскопічних втручань у 31 хворого з приводу портальної біліопатії (ПБ). У 7 (23%) хворих ПБ виникла на тлі тромбозу ворітної вени (ВВ), у 19 (61%) - виявлені клінічні ознаки, пов’язані з ураженням жовчних проток: холедохолітіазу (у 16%), стриктури (у 35%), папілостенозу, що супроводжувалося гіпербілірубінемією, жовтяницею, холангітом. Діагностичний комплекс включав ультразвукове дослідження (УЗД) з допплерографією, контрастно-підсилену комп’ютерну томографію (КТ), магніторезонансну холангіопанкреатикографію (МРХПГ), діагностичну та лікувальну ендоскопічну ретроградну холангіографію (ЕРХГ) з папілосфінктеротомією (ЕПСТ), літоекстракцією, ендобіліарним стентуванням. Ендоскопічні транспапілярні втручання, не усуваючи основну патогенетичну причину ПБ - портальну гіпертензію (ПГ), дозволяють у більшості хворих вирішити проблеми біліарної гіпертензії.

Use of gadoxetic acid for computed tomographic cholangiography in healthy dogs.

OBJECTIVE To evaluate the effect of gadoxetic acid (contrast) dose on biliary tract enhancement, determine the optimal time after contrast injection for CT image acquisition, and assess the feasibility of CT cholangiography in sedated dogs. ANIMALS 8 healthy dogs. PROCEDURES The study had 2 parts. In part 1, 4 dogs were anesthetized and underwent CT cholangiography twice. Gadoxetic acid was administered IV at a low dose (0.025 mmol/kg) for the first procedure and high dose (0.3 mmol/kg) for the second procedure. Serial CT scans were obtained at predetermined times after contrast injection. In part 2, 4 dogs were sedated and underwent CT angiography 85 minutes after IV administration of the high contrast dose. Contrast enhancement of the biliary tract on all scans was objectively assessed by measurement of CT attenuation and qualitatively assessed by use of a subjective 4-point scoring system by 3 independent reviewers. All measurements were compared over time and between contrast doses for the dogs of part 1. Subjective measurements were compared between the sedated dogs of part 2 and anesthetized dogs of part 1. RESULTS Enhancement of the biliary tract was positively associated with contrast dose and time after contrast injection. Optimal enhancement was achieved 65 minutes after contrast injection. Subjective visualization of most biliary structures did not differ significantly between sedated and anesthetized dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated CT cholangiography with gadoxetic acid was feasible in sedated dogs. The high contrast dose provided better visualization of biliary structures than the low dose; CT scans should be obtained 65 minutes after contrast injection.

Endoscopic Treatment of Early Biliary Complications in Liver Transplant Recipients.

The most common complications following liver transplantation (LTx) concern the biliary ducts. Potential early complications are biliary leaks and anastomotic strictures of the bile duct. The aim of this study was to evaluate the efficacy of endoscopic treatment of early biliary complications in liver transplant recipients after end-to-end biliary anastomosis. From January 2011 to December 2013, 475 patients underwent LTx at our Department. There were 101 endoscopic procedures performed in total during this period, out of which 67 were related to biliary complications in 44 patients, while the remaining procedures were carried out due to gastrointestinal bleeding. We established a timeframe of up to 3 months postoperatively as the early biliary complication period. With the selected criteria we retrospectively analyzed medical records of 24 liver recipients who underwent endoscopic treatment due to early biliary complications. The outcome of endoscopic treatment was statistically analyzed and categorized as a technical and clinical success. During this period there were 38 endoscopic procedures in the analyzed group of patients treated due to early biliary complications. The results were: successful balloon dilation alone was performed in 2 patients with no further need of treatment, implantation of plastic stents was performed initially in 13 patients, but 7 patients required further stenting with larger caliber plastic stents (PS). Self-expandable metal stents (SEMS) were initially placed in 7 patients during this period overall. One patient was treated due to hemobilia. In 1 case endoscopic retrograde cholangiopancreatography (ERCP) was unfeasible and the patient required surgical intervention. In 1 case a PS was exchanged for an SEMS. Six patients with satisfactory cholangiography images had the stent removed during the second ERCP. In consideration of the stabilized rate of biliary complications following LTx, an advanced transplant center cannot function without an experienced endoscopist. For early biliary leaks and anastomotic strictures, ERCP is the primary treatment.

Gallstone Disease

Gallstone disease (cholelithiasis), very common in the United States, afflicts around 15% of the adult population and accounts for approximately 1.8 million ambulatory visits per year. Elective laparoscopic cholecystectomy for the removal of gallstones is currently the most commonly performed abdominal operation in the United States, with around 750,000 operations per year. Although the majority of patients with asymptomatic gallstones will never develop symptoms, approximately 25% of these initially asymptomatic patients will develop biliary pain and 3% will develop complications over a 10-year follow-up period. This review discusses the pertinent pathophysiology and treatment of gallstones and their complications. It is imperative for the primary care physician, gastroenterologist, and surgeon to rapidly identify those patients at risk for complications of gallstone disease and offer the best evidence-based therapies available. It is also important for the physician to understand when and if to offer treatment for those patients with asymptomatic gallstone disease. Figures show the mixed micelle, the anatomy of gallstones, radial endoscopic sonogram of a gallstone in common bile duct (CBD), an algorithm depicting the risk of CBD stone in patients with known cholelithiasis, and endoscopic retrograde cholangiography images of a large gallstone within CBD and stone fragments in duodenum following lithotripsy and extraction. Tables list risk factors for gallstone formation, common medications associated with gallstone formation, and uncommon complications of gallstone disease. This review contains 5 highly rendered figures, 3 tables, and 53 references.

Image of the month-quiz case.

A 34-YEAR-OLD MAN PRESENTED WITH GAStrointestinal bleeding related to esophageal varices in 2002. The patient’s varices were controlled with endoscopic ligation. Evaluation of the cause of the varices revealed extrahepatic portal vein thrombosis with normal findings on liver biopsy. During the follow-up period, he was found to have an increased alkaline phosphatase level; no other laboratory abnormalities of the liver were found, including the serum bilirubin level. The intrahepatic biliary ductal dilation was documented by computed tomographic cholangiography (Figure 1). A biliary stent was placed endoscopically with normalization of the alkaline phosphatase level. Computed tomographic portography demonstrated a patent intrahepatic portal vein and a patent confluence of the splenic and superior mesenteric veins, but with an occluded portal vein between the confluence and the intrahepatic portal vein with extensive venous collaterals.

The role of endoscopy in the management of choledocholithiasis

The role of endoscopy in the management of choledocholithiasis

Diagnosis and treatment of pancreaticobiliary maljunction in children

Pancreaticobiliary maljunction (PBM), which may be called by synonymous terms such as "anomalous arrangement of the pancreaticobiliary duct" or "anomalous union of biliopancreatic ducts," is defined as an anatomical maljunction of the pancreatic duct and the biliary duct outside of the duodenal wall beyond the influence of the sphincter of Oddi. Pancreaticobiliary maljunction is classified into three groups according to the type of the pancreaticobiliary junction. Pancreaticobiliary maljunction is diagnosed mainly by endoscopic retrograde cholangiopancreatography; however, in pediatric patients, it may be diagnosed by intraoperative cholangiography, and more recently has been diagnosed by computed tomographic cholangiography or contrast-enhanced helical computed tomography. Children with PBM without choledochal cysts usually do not show any symptoms except for abdominal pain and hyperamylasemia. Pancreaticobiliary maljunction is considered to be a major risk factor for biliary tract malignancy. In patients with PBM, free reflux of pancreatic juice into the biliary tract might induce biliary tract damage and biliary carcinogenesis. Thus, total resection of the extrahepatic bile duct and hepaticojejunostomy are recommended in children diagnosed with PBM with choledochal cyst. Early diagnosis and early surgical treatment provide a good prognosis with few complications. In addition, successive follow-up is necessary for early detection of biliary tract malignancy, especially in patients demonstrating postoperative complications.

Computed Tomographic Cholangiography in Living Liver Transplant Donors

To determine factors affecting liver and bile duct contrast enhancement during computed tomographic cholangiography (CTC) in living-donor transplant candidates. Forty-four candidates underwent preoperative triphasic CT followed by intravenous infusion of 20 mL of iodipamide for CTC. Body size indices and liver volume were correlated to parenchymal and biliary enhancement. Bile duct visibility was compared to duct enhancement. Poorly visualized first- and second-order bile ducts demonstrated diminished enhancement (P < 0.015). Both CTC parenchymal and biliary enhancement correlated inversely with body surface area, height, and weight (P < 0.001); inverse correlation was also seen between liver volume and parenchymal enhancement (P < 0.001). A moderately positive correlation was noted between CTC biliary and parenchymal portal venous enhancement (r = 0.421; P = 0.004). Computed tomographic cholangiography parenchymal and biliary enhancement diminishes with increased body size and liver volume, supporting a need for adjustable contrast dosing. Portal venous parenchymal enhancement may serve as a preinfusion indicator.

Gadoxetic acid disodium‐enhanced magnetic resonance imaging for biliary and vascular evaluations in preoperative living liver donors: Comparison with gadobenate dimeglumine‐enhanced MRI

To compare gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI in preoperative living liver donors for the evaluation of vascular and biliary variations. Sixty-two living liver donors who underwent preoperative MRI were included in this study. Thirty-one patients underwent MRI with Gd-EOB-DTPA enhancement, and the other 31 underwent MRI with Gd-BOPTA enhancement. Two abdominal radiologists retrospectively reviewed dynamic T1-weighted and T1-weighted MR cholangiography images and ranked overall image qualities for the depiction of the hepatic artery, portal vein, hepatic vein, and bile duct on a 5-point scale and determined the presence and types of normal variations in each dynamic phase. Semiquantitative analysis for bile duct visualization was also conducted by calculating bile duct-to-liver contrast ratios. No statistical differences were found between the two contrast media in terms of hepatic artery or bile duct image quality by the two reviewers, or in terms of portal vein image quality by one reviewer (P > 0.05). Gd-BOPTA provided better image qualities than Gd-EOB-DTPA for the depiction of hepatic veins by both reviewers, and for the depiction of portal veins by one reviewer (P < 0.01). The two contrast media-enhanced images had similar bile duct-to-liver contrast ratios (P > 0.05). Regarding diagnostic accuracies with hepatic vascular/biliary branching types, no significant differences were observed between the two contrast media (P > 0.05). Gd-EOB-DTPA could be as useful as Gd-BOPTA for the preoperative evaluation of living liver donors, and has the advantage of early hepatobiliary phase image acquisition.

Management of Complicated Recurrent or Residual Hepatolithiasis

As the patterns of gallstone disease have changed, those with recurrent or residual hepatolithiasis (the so-called complicated hepatoliththiasis) are becoming more and more problematic. How to treat them properly is a new challenge. Contrast cholangiography as well as computed tomography or magnetic resonance cholangiography is necessary to delineate the location of stones, duct strictures, and possible coexisting malignancy preceding surgical or other biliary interventions. Resection of the involved segment or lobe of the liver is a safe and effective treatment for localized hepatolithiasis. Cholangioscopic lithotomy, either intraoperative, postoperative, or a percutaneous minimally invasive procedure without reoperation is important in stone eradication. Chemical biliary duct embolization to prevent stone recurrence has recently been reported. The antagonist of the epidermal growth factor receptor might suppress proliferative cholangitis in animal studies. To obtain a good long term outcome, it is important to keep in mind the possibility of coexisting intrahepatic cholangiocarcinoma, either before, during, or after treatment of complex hepatolithiasis. For complicated hepatolithiasis, a systematic approach with multimodal treatment by a cooperative team is recommended.

Image of the Month—Quiz Case

A 34-YEAR-OLD MAN PRESENTED WITH GAStrointestinal bleeding related to esophageal varices in 2002. The patient’s varices were controlled with endoscopic ligation. Evaluation of the cause of the varices revealed extrahepatic portal vein thrombosis with normal findings on liver biopsy. During the follow-up period, he was found to have an increased alkaline phosphatase level; no other laboratory abnormalities of the liver were found, including the serum bilirubin level. The intrahepatic biliary ductal dilation was documented by computed tomographic cholangiography (Figure 1). A biliary stent was placed endoscopically with normalization of the alkaline phosphatase level. Computed tomographic portography demonstrated a patent intrahepatic portal vein and a patent confluence of the splenic and superior mesenteric veins, but with an occluded portal vein between the confluence and the intrahepatic portal vein with extensive venous collaterals.

Estadificación del cáncer de vesícula mediante tomografía de positrones con 18F-fluorodesoxiglucosa

Gallbladder cancer is the most common biliary tract neoplasm. It generally affects the elderly, who are usually clinically asymptomatic. When symptoms appear, they suggest the presence of complications locally or due to tumour progression. Late diagnosis of the disease indicates a poor prognosis for these patients. Surgery is the only treatment with curative intent, but it is only possible in the early stages. Diagnostic imaging of this type of tumour is usually performed with ultrasonography, computed tomography or magnetic resonance cholangiography. Positron emission tomography (PET) with fluorodeoxyglucose (FDG) with dedicated scanners or hybrid PET-CT scans are new diagnostic tools which could help in the pre-surgical diagnosis of these tumours. We present three cases to illustrate the usefulness of PET-FDG in the pre-surgical staging of gallbladder cancer.

O papel da colangiografia por ressonância magnética na avaliação da anatomia biliar em doadores de transplante hepático intervivos

OBJETIVO: Avaliar a acurácia da colangiografia por ressonância magnética no estudo da anatomia biliar de doadores de fígado em correlação com achados operatórios. MATERIAIS E MÉTODOS: Estudo retrospectivo de 50 doadores submetidos a transplante hepático intervivos no Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. As colangiografias foram analisadas e os resultados dos exames foram comparados com os achados intra-operatórios. Apenas alterações anatômicas que promoveram mudança de estratégia cirúrgica, não-evidenciadas previamente pela colangiografia por ressonância magnética, foram consideradas como discordantes. RESULTADOS: Foram encontradas variações pela colangiografia por ressonância magnética em 7 doadores e em 14 durante a cirurgia. Do total de pacientes, 41 resultados foram concordantes e 9 foram discordantes. A sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acurácia da colangiografia por ressonância magnética foram, respectivamente, de 43%, 97%, 86%, 81% e 81,6%. CONCLUSÃO: Conclui-se que a ressonância magnética é um método de imagem seguro e não-invasivo para avaliação pré-operatória das vias biliares de doadores e que algumas anomalias não são detectadas pela colangiografia por ressonância magnética.