Background: Recent years have witnessed a rapid and continuous evolution in the diagnosis of biliary obstructive disease. Traditional methodologies, such as US (ultrasonography), CT (computed tomography), ERCP (endoscopic retrograde cholangiopancreatography) and PTC (percutaneous transhepatic cholangiography), have been supplemented by MRCP (magnetic resonance cholagiopancreatography) and CCT (cholangio computed tomography) The purpose of our study was to compare the reliability of diagnostic US, MR and other imaging techniques in intrinsic biliary obstructive disease.
Material/Methods: Between June 1999 and July 2003 we conducted a prospective study on 131 patients – 60 males and 71 females – ranging in age from 37 to 79 years, with clinical features of biliary obstructive disease. Imaging studies were done on each patient using several different techniques. The US, MRCP, CCT and ERCP results were read by radiologists blinded to other imaging fi ndings.
Results: US is generally accurate in diagnostic imaging of obstructive biliary disease. MRCP and CCT are signifi cantly more accurate only in completing the staging of malignant stenosis.
Conclusions: If the suspicion posed by clinical and laboratory fi ndings is not confi rmed at US, the diagnosis must be achieved with the aid of MRCP or – where MRCP does not provide a diagnosis – CCT, so
as to select candidates for therapeutic ERCP, PTC or surgery. If laboratory and clinical fi ndings are supported by US, ERCP is required for therapeutic purposes, or – if necessary – surgery is performed.

Keywords: Biliary Tract Diseases - diagnosis, Biliary Tract Diseases - pathology, Biliary Tract Diseases - radiography, Biliary Tract Diseases - ultrasonography, Biliary Tract Diseases - ultrasonography, Cholangiography, Cholangiopancreatography, Endoscopic Retrograde, Endosonography, Italy, Magnetic Resonance Imaging, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed