Cholangiography is the most fundamental and reliable examination for diagnosis of the extent of bile duct carcinoma. Hepatic angiography is also informative for diagnosis of vascular invasion. However, an accurate understanding of three-dimensional biliary and vascular anatomy at the hepatic hilum is not easily gained by conventional cholangiography and angiography. We have performed three-dimensional cholangiography and angiography (3D-CG & AG) using rotational DSA (Advantx ACT) and a 3D spinning digital imaging system in 29 patients with hilar cholangiocarcinoma, etc. 3D-CG & AD provides clear three-dimensional visualization of the biliary tract and blood vessels affected by bile duct cancer, and useful information on optimal resection. Of 13 patients with hilar cholangiocarcinoma undergoing resection, curative resection was carried out in 11 (85%). 3D-CG & AG is considered to be an indispensable imaging modality for evaluation of the extent and staging of hilar cholangiocarcinoma.