The Ewha Medical Journal
Ewha Womans University School of Medicine
Review

Imaging findings of intrahepatic cholangiocarcinoma for prognosis prediction and treatment decision-making: a narrative review

Jun Gu Kang1,2, Taek Chung3, Dong Kyu Kim1,2, Hyungjin Rhee1,2,*
1Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
2Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science, and Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul 03722, Korea.
3Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
*Corresponding Author: Hyungjin Rhee, Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea, Republic of. Research Institute of Radiological Sciences, Center for Clinical Imaging Data Science, and Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul 03722, Korea, Republic of. Phone: +82-2-2228-2353. E-mail: hjinrhee@yuhs.ac.

© Copyright 2024 Ewha Womans University School of Medicine. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Sep 30, 2024; Accepted: Oct 02, 2024

Published Online: Oct 31, 2024

Abstract

Intrahepatic cholangiocarcinoma (iCCA) is a heterogeneous bile duct adenocarcinoma with a rising global incidence and a poor prognosis. This review aims to present a comprehensive overview of the most recent radiological research on iCCA, focusing on its histopathologic subclassification and the use of imaging findings to predict prognosis and inform treatment decisions. Histologically, iCCA is subclassified into small duct (SD-iCCA) and large duct (LD-iCCA) types. SD-iCCA typically arises in the peripheral small bile ducts and is often associated with chronic hepatitis or cirrhosis. It presents as a mass-forming lesion with a relatively favorable prognosis. LD-iCCA originates near the hepatic hilum, is linked to chronic bile duct diseases, and exhibits more aggressive behavior and poorer outcomes. Imaging is essential for differentiating these subtypes and assessing prognostic factors like tumor size, multiplicity, vascular invasion, lymph node metastasis, enhancement patterns, and intratumoral fibrosis. Imaging-based prognostic models have demonstrated predictive accuracy comparable to traditional pathological staging systems. Furthermore, imaging findings are instrumental in guiding treatment decisions, including those regarding surgical planning, lymphadenectomy, neoadjuvant therapy, and the selection of targeted therapies based on molecular profiling. Advancements in radiological research have improved our understanding of iCCA heterogeneity, facilitating prognosis prediction and treatment personalization. Imaging findings assist in subclassifying iCCA, predicting outcomes, and informing treatment decisions, thus optimizing patient management. Incorporating imaging-based approaches into clinical practice is crucial for advancing personalized medicine in the treatment of iCCA. However, further high-level evidence from international multicenter prospective studies is required to validate these findings and increase their clinical applicability.

Keywords: Intrahepatic cholangiocarcinoma; Diagnostic imaging; Histopathology; Prognosis; Precision medicine