Percutaneous transhepatic cholangiography has been attempted in 104 patients with jaundice due to a variety of causes. Biliary tract visualization was accomplished in 57, the majority having extrahepatic obstruction due to malignancy or calculi. Nonvisualization (a "negative" study) or a normal cholangiogram, was commonly associated with parenchymal liver disease which was confirmed by percutaneous needle liver biopsy. With an injection technique and television roentgen monitoring, false negative studies have been eliminated in patients with dilated intrahepatic bile ducts, and even normal ducts can be visualized. Needle liver biopsy has become an alternative to unproductive biliary tract exploration.
James M. Normal or "Negative" Percutaneous Cholangiogram. Arch Surg. 1971;103(1):31-33. doi:10.1001/archsurg.1971.01350070057012