Advancements in imaging techniques are transforming personalised treatment strategies for hepatobiliary and pancreatic neoplasms. Radiologic findings now provide valuable insights into tumour biology, aiding prognosis and therapy selection. The integration of imaging features with histopathologic, molecular and immunologic characteristics enables more precise treatment approaches. As a result, imaging plays a critical role in identifying patients most likely to benefit from specific interventions, including surgery, systemic therapies and targeted treatments. A recent article published in RadioGraphics explores the essential predictive imaging features associated with hepatocellular carcinoma (HCC), colorectal liver metastases (CRLM) and pancreatic ductal adenocarcinoma (PDAC), highlighting their influence on clinical decision-making and patient outcomes.
Predictive Imaging in Hepatocellular Carcinoma (HCC)
HCC is characterised by diverse biological properties that influence tumour behaviour, treatment response and prognosis. Imaging techniques such as contrast-enhanced CT and MRI provide non-invasive means of assessing these biological characteristics, facilitating treatment planning. Specific imaging findings, such as rim arterial phase hyperenhancement and peritumoural hypointensity in the hepatobiliary phase, have been associated with more aggressive tumour subtypes. These features correlate with histopathological markers, including microvascular invasion and high tumour grade, both of which contribute to poor clinical outcomes.
The ability to identify these features before treatment is critical in guiding therapy selection. Radiologic assessments can inform decisions regarding systemic therapy, particularly when considering immune checkpoint inhibitors and molecularly targeted agents. Tumours exhibiting certain imaging characteristics, such as peritumoural hypointensity, have shown associations with increased infiltration of CD8+ T cells and PD-L1 expression, which may predict responsiveness to immunotherapy. Additionally, the presence of an enhancing capsule around the tumour has been linked to better survival rates following locoregional therapies. These imaging biomarkers provide oncologists with a more detailed understanding of tumour biology, allowing for a more individualised therapeutic approach that maximises the likelihood of successful treatment outcomes.
Colorectal Liver Metastases (CRLM) and Imaging-Based Prognosis
The management of CRLM depends on a combination of surgical and systemic therapies, with treatment plans tailored to individual patient characteristics. Imaging plays a crucial role in predicting tumour response and assessing histopathologic growth patterns, which are directly linked to clinical prognosis. Contrast-enhanced MRI and CT scans provide insight into the tumour’s microenvironment, aiding in therapy selection.
Rim enhancement in either the arterial or portal venous phase has been associated with specific histopathologic growth patterns, which in turn influence treatment response. The desmoplastic growth pattern, for example, correlates with a positive response to bevacizumab-containing chemotherapy, while the replacement growth pattern indicates a more aggressive tumour with a poorer prognosis. Additionally, increased tumour calcification following cetuximab therapy has been identified as a marker of prolonged overall survival, providing further evidence of the value of imaging in predicting patient outcomes.
The hepatobiliary phase of MRI also offers important predictive insights. Tumours exhibiting delayed enhancement are often rich in connective tissue, which affects drug delivery and retention. These features have been linked to improved responses to oxaliplatin-based chemotherapy, helping oncologists determine the most effective systemic treatment strategies. The ability to assess these features before initiating therapy is crucial for optimising treatment selection, improving the likelihood of tumour resectability and enhancing long-term survival prospects.
Pancreatic Ductal Adenocarcinoma (PDAC) and Imaging-Guided Treatment
PDAC remains one of the most challenging malignancies to treat, with a high likelihood of recurrence even after surgical resection. Imaging biomarkers play a vital role in distinguishing between tumours that may be suitable for immediate surgery and those requiring neoadjuvant therapy. Isoattenuation in the arterial and portal venous phases on CT scans has been linked to well-differentiated tumours with less invasive potential, supporting the case for upfront surgical intervention. Conversely, tumours displaying rim enhancement in the arterial phase often contain significant intratumoural necrosis, a marker of hypoxia-driven tumour aggression. Such cases require careful management, as they are associated with poorer survival outcomes.
Diffusion-weighted MRI findings also offer valuable prognostic information. Tumours with lower apparent diffusion coefficient (ADC) values are more likely to demonstrate extrapancreatic nerve invasion, increasing the risk of local recurrence. As a result, ADC measurements can help in stratifying patients according to their risk profile, guiding decisions regarding the need for perioperative chemotherapy.
Another important imaging biomarker in PDAC is delayed enhancement on contrast-enhanced CT. This feature, indicative of a dense fibrotic stroma, has been associated with variable clinical outcomes. While fibrosis may serve as a protective barrier confining tumour cells, it can also promote tumour progression by limiting drug penetration. Nevertheless, quantitative assessment of extracellular volume fraction in delayed enhancement imaging has shown promise in predicting responses to chemotherapy, particularly in unresectable PDAC cases. These findings suggest that imaging-based assessments could be incorporated into treatment planning, allowing for better patient selection and therapy optimisation.
Predictive imaging features have become indispensable tools in modern oncology, providing critical insights into the biological characteristics of hepatobiliary and pancreatic neoplasms. By integrating radiologic findings with histopathologic, molecular and genetic data, clinicians can make more informed decisions about treatment strategies, ultimately improving patient outcomes. Imaging phenotypes have independent prognostic value and should be considered alongside traditional classification systems to refine therapeutic approaches. As imaging technology continues to evolve, its role in precision medicine will expand, offering greater opportunities for personalised cancer treatment and better clinical management of these complex malignancies.
Source: RadioGraphics
Image Credit: iStock
