title: Accuracy of percutaneous transhepatic cholangiography in predicting the location and nature of major bile duct injuries.
abstract: OBJECTIVE
  To determine the ability of percutaneous transhepatic cholangiography (PTC) to predict accurately the anatomic location and nature of major bile duct injuries, to examine the contribution of endoscopic retrograde cholangiopancreatography (ERCP) and PTC to the diagnosis of injuries to the low-inserting right posterior segmental ducts, and to compare the ability of radiologists and gastroenterologists to detect injuries to the low-inserting right posterior segmental duct.
  
  
  METHODS
  PTC images and operative reports of 78 consecutive patients who underwent surgical repair of major bile duct injuries at the authors' institution were retrospectively reviewed. The location of injury was assessed according to the Bismuth classification. Images were also evaluated for the presence of a biliary stricture, biliary leak, or both. Imaging observations were compared with findings obtained during surgical biliary reconstruction.
  
  
  RESULTS
  PTC correctly predicted the anatomic location of injuries in 85% of patients. Incorrect Bismuth type was assigned in 12 patients. Seven of the errors (58%) originated from the inability to distinguish injuries at the confluence of the lobar ducts from injuries involving the cephalad 2 cm of the common hepatic duct. Injuries to the right posterior segmental duct were detected more often on ERCP images by gastroenterologists than by diagnostic radiologists. In four patients (5%), biliary strictures were masked on PTC by the presence of a concomitant leak.
  
  
  CONCLUSIONS
  PTC accurately depicts the location and nature of major bile duct injuries in most patients.
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA 94143. USA. Nicholas.Fidelman@radiology.ucsf.edu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Laberge
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
mesh_terms: D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012495:San Francisco; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery