Hepatobiliary and Pancreatic Neoplasms: Essential Predictive Imaging Features for Personalized Therapy

Abstract

Tumor biologic characteristics encompassing histopathologic, immune microenvironmental, genetic, and molecular aspects are becoming indispensable factors to be considered in treatment strategies for patients with cancer. Innovations in oncologic treatment have broadened the range of therapeutic approaches and now hold promise for treatments personalized according to tumor biologic characteristics. Particularly for hepatobiliary and pancreatic neoplasms, the advent of cytostatic agents such as molecularly targeted agents and immune checkpoint inhibitors, which differ markedly from conventional cytotoxic agents, has contributed to advances in clinical practice. These cytostatic agents increase the potential for curative-intent treatment of unresectable cancers by reducing tumor volume. Radiologic examinations are of more interest than ever to noninvasively obtain information about tumor biologic features. Radiomics represents an invaluable research method for elucidating associations between tumor biologic characteristics and radiologic imaging findings, but their applicability in daily clinical practice remains challenging. Various radiologic predictive findings for tumor biologic characteristics have already been proposed for hepatobiliary and pancreatic neoplasms. Radiologists must gain familiarity with these findings and the roles they have in predicting the clinical prognosis and treatment efficacy. In addition, radiologists should explore the potential applications of these imaging findings to current treatment strategies for the coming era of personalized medicine. The authors describe predictive findings using CT and MRI for diagnosis of hepatocellular carcinoma, colorectal liver metastases, intrahepatic cholangiocarcinoma, and pancreatic adenocarcinoma, with correlations to pathologic, immunologic, molecular, and genetic background factors. ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Ronot in this issue.