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The imaging spectrum and nuances of intrahepatic cholangiocarcinoma: a narrative review

Objective: To present the imaging spectrum and nuances of intrahepatic cholangiocarcinoma (IHCC), with particular emphasis on mass-forming IHCC and its evaluation with magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT). Background: The rationale for this review is the importance of optimal imaging evaluation throughout the diagnosis and management of each patient with IHCC. Methods: PubMed was searched using the terms “intrahepatic cholangiocarcinoma imaging” from 2000 to February 2021, with the search then focused to the radiology literature. Surgical oncology and pathology literature pertinent to the discussion were also referenced. Conclusions: The authors’ intention is that this review will serve as a valuable resource for medical professionals with interest in the imaging of IHCC. A major portion of this review is a presentation of the typical and atypical imaging features of IHCC with histopathologic explanations for these features, and the potential overlap of these features with other tumors including atypical HCC and combined HCC-CC. The roles of serum tumor markers and tissue diagnosis as potential differentiators between imaging mimics are discussed. The imaging techniques that are most commonly utilized in IHCC characterization and disease extent determination, and their advantages and limitations are presented. The review concludes with a discussion of the clinicoprognostic implications of particular morphologic and contrast enhancement characteristics of IHCC. LR-M) shape, rim enhancement during arterial phase, absence of target appearance on hepatobiliary phase images, presence of major vascular thrombosis, and absence of intrahepatic biliary dilatation may favor cHCC-CC over IHCC May have elevated AFP and CA 19-9 Variable tumor type, multiple or malignancy Tumor markers may be elevated depending on primary type