cholangiografie

Cholangiography, or cholangiografie in Dutch, is the radiographic imaging of the biliary tree using contrast material to visualize the bile ducts and assess their anatomy and pathology. The technique is used to identify biliary obstruction, choledocholithiasis (bile duct stones), strictures, leaks after surgery, and to aid in planning or guiding interventions.

There are several approaches. Percutaneous transhepatic cholangiography (PTC) involves inserting a needle into intrahepatic bile ducts under imaging guidance and injecting contrast to outline the ductal system, often followed by drainage or therapeutic procedures. Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy with contrast injection into the biliary system via the duodenum and allows both diagnostic imaging and therapeutic maneuvers such as stone extraction or stent placement. Intraoperative cholangiography (IOC) is performed during surgery, typically cholecystectomy, by injecting contrast into the cystic duct to delineate biliary anatomy and detect stones. Magnetic resonance cholangiopancreatography (MRCP) uses noninvasive MRI, mainly heavily T2-weighted sequences, to visualize the biliary tree without iodinated contrast; CT cholangiography is another imaging option, using CT after contrast administration.

Indications include evaluation of suspected biliary obstruction or anatomy before procedures, assessment of strictures or leaks, and planning or guidance for drainage or stenting. MRCP is preferred when noninvasive imaging suffices, while ERCP provides therapeutic possibilities. Risks vary by modality: ERCP carries pancreatitis, cholangitis, perforation, and sedation risks; PTC and IOC have risks of bleeding, infection, bile leak, and radiation exposure.