Radiomics for Detection and Differentiation of Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis

Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary liver malignancy with limited survival, largely due to delayed diagnosis, recurrence and limited effective therapeutic options. Radiomics- and artificial intelligence (AI)-based imaging models have emerged as promising tools to improve noninvasive detection and differentiation of ICC. We conducted a systematic review and meta-analysis to evaluate the diagnostic performance of radiomics-based AI models for ICC.

A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was performed from inception through 2025 in accordance with PRISMA guidelines. Studies assessing radiomics- or AI-based models derived from CT, MRI, PET, or ultrasound for differentiation of ICC from other hepatic lesions were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were estimated using a bivariate random-effects model. Study quality and risk of bias were assessed using the Radiomics Quality Score (RQS) and QUADAS-2 tools.

Twenty retrospective studies comprising 8746 participants were included. Across pooled validation and test datasets, radiomics-based AI models demonstrated a pooled sensitivity of 0.77 (95% CI, 0.69-0.84) and specificity of 0.88 (95% CI, 0.78-0.94) for differentiating ICC from non-ICC hepatic lesions. The pooled PLR was 6.81 (95% CI, 3.51-13.2), and the pooled NLR was 0.23 (95% CI, 0.09-0.61). CT-based models showed higher diagnostic performance compared with MRI and ultrasound. Subgroup and meta-regression analyses identified imaging modality, contrast phase, segmentation strategy, and validation approach as contributors to interstudy heterogeneity. The overall methodological quality demonstrated a mean Radiomics Quality Score (RQS) of 14.0 (range 11-24), corresponding to approximately 39% of the maximum achievable score. External validation cohorts were incorporated in 60% of the studies, although adherence to standardized feature reproducibility frameworks varied.

Radiomics-based AI models demonstrate clinically meaningful diagnostic accuracy for noninvasive differentiation of ICC and may complement conventional imaging in preoperative evaluation. Prospective, multicenter studies with standardized imaging protocols and rigorous external validation are required before routine clinical adoption.