Abstract:Objective:To evaluate the clinical value of MR cholangiopancreatography (MRCP) as the only imaging procedure in diagnosing biliary complications after orthotopic liver transplantation (OLT). Methods: The MRCP results were analyzed in 54 consecutive patients presented with clinical or biochemical signs of biliary complications after receiving OLT, and were compared with the findings eventually confirmed by surgery, direct cholangiography, and clinical follow-up. Two different MRCP snapshot techniques were applied: thick-slab T2-weighted sequences and multi-section thin-slab T2-weighted sequences. Results: Surgery, direct cholangiography, and clinical follow-up confirmed that 36 patients had biliary complications. MRCP had a sensitivity of 100% (36/36) in diagnosing biliary complications after OLT, with a positive predictive value of 91.7% (33/ 36), a false-positive rate of 5.56% (2/36), and an overall diagnostic accuracy of 94.4%(51/54). MRCP as the only imaging procedure achieved a specific diagnosis in 96.3% (52/54) of the patients in the present study. Only 2 patients required additional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholecystostomy. Direct cholangiography was required only as a therapeutic procedure in 25.9% (14/54) of the patients. Conclusion: MRCP is an effective imaging procedure in the assessment of biliary complications after OLT. Direct cholangiography is not needed for diagnosis but should be reserved as a therapeutic procedure.