OBJECTIVE. The goal of the present study was to determine the added value of gadolium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced magnetic resonance cholangiography (MRC) to standard liver MRI including T2-weighted MRCP in assessment of biliary ductal obstruction. MATERIALS AND METHODS. Thirty-eight patients (mean age, 48.1 ± 16.7 years) (40 total examinations) who underwent liver MRI (including T2-weighted MRCP and gadoxetate disodium-enhanced MRC) for suspicion of biliary disease were included in this institutional review board-approved, HIPAA-compliant retrospective study. Three blinded radiologists first evaluated MR images without gadoxetate disodium-enhanced MRC for presence and significance of biliary obstruction, underlying cause for obstruction, and confidence in final diagnosis. After inclusion of gadoxetate disodium-enhanced MRC, readers again determined presence and significance of biliary obstruction and confidence in final diagnosis. Reference standard was established using MRI along with ERCP, percutaneous transhepatic cholangiography, intraoperative cholangiography, or a combination thereof. RESULTS. Overall sensitivity across all readers in diagnosing significance of obstruction was 60% without gadoxetate disodium-enhanced MRC and 91% with gadoxetate disodium- enhanced MRC (p < 0.001). Across all readers, assessment of significance of obstruction was changed when adding gadoxetate disodium-enhanced MRC in 40 of 120 cases (33%); significance of obstruction was correctly changed in 35 of 40 cases (87.5%). Biliary obstruction was graded of unknown significance in 27 of 120 cases (22.5%) across all readers when gadoxetate disodium-enhanced MRC was not reviewed. Significance of biliary obstruction was classified correctly after adding gadoxetate disodium-enhanced MRC in 25 of these 27 cases (93%). Confidence in final diagnosis was significantly higher with addition of gadoxetate di-sodium-enhanced MRC for two of three readers (p < 0.003). CONCLUSION. Addition of gadoxetate disodium-enhanced MRC to liver MRI significantly improves sensitivity in assessing significance of biliary obstruction and can improve reader confidence in establishing a final diagnosis. This added information could have a substantial impact in the determination of the most appropriate therapeutic options.