Hepatoportal cholangiocarcinoma is a biliary mucosal epithelial carcinoma located in the common hepatic duct above the opening of the cystic duct, the confluence of the left and right hepatic ducts and the left and right hepatic duct. Its surgery is difficult and the patient’s prognosis is poor. Diagnosis is mainly made through imaging examinations, including ultrasound, CT, magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transluminal cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), PET-CT, etc. CT examination: It is simple, non-invasive and one of the most important screening methods, which can not only diagnose cholangiocarcinoma in the hilar region, but also determine the scope of local invasion, vascular invasion and lymph node metastasis. MRI and MRCP examination: with the advantage of non-invasive, it can image the proximal and distal parts of bile duct obstruction at one time to obtain high-quality bile duct images and clearly show the whole bile duct, which is more instructive for clinical staging. Among them, the combined application of CT and MRCP can show the relationship between the tumor and the surrounding blood vessels. PET-CT examination: It has both localization and qualitative effects, and has certain judgment for lymph node metastasis and distant metastasis, but the sensitivity for primary tumor is low. And this method is expensive, so it is not recommended as a routine diagnostic tool. PTC and ERCP: They can be used to determine the extent of hilar cholangiocarcinoma; PTC can visualize the bile ducts above the obstruction site, and ERCP can show the bile ducts below the obstruction site. Both can be placed and bile drainage can be performed to reduce yellowing. However, both are invasive, and ERCP may also induce acute pancreatitis. Currently, PTC and ERCP are less used in the diagnosis of hilar cholangiocarcinoma and are gradually replaced by MRCP. Doctor’s tip: Although there are many diagnostic imaging methods, each method has its advantages and limitations. Therefore, in general, the diagnosis of hilar cholangiocarcinoma should not rely solely on one examination method, but should be based on a comprehensive assessment and control of the respective advantages and disadvantages of imaging examination methods, and if necessary, multiple examination methods should be used in combination, so as to help diagnose more accurately.