淋巴结（LN）成像检查异常结果显示病理淋巴结转移（LNM）的诊断准确率不尽如人意。我们旨在基于MRI和临床结果，开发和验证一个简单的评分系统，用于预测肝内胆管癌（iCCA）患者术前LNM。我们回顾性地纳入了2009年1月至2015年12月，在六个医疗机构接受手术治疗的治疗原发性iCCA的连续患者。接受淋巴结切除术（LND）的患者以2：1的比例随机分配到训练和验证队列，评估病理LN状态。未接受LND的患者分配到测试队列，并评估临床LN状态。使用MRI和临床结果，开发了术前LNM评分，在训练队列中进行验证，并在验证和测试队列中进行评估。训练、验证和测试队列分别包括102、53和118名患者。术前LNM评分包括血清癌胚抗原和两项MRI结果（可疑LN和胆管侵犯）。术前LNM评分与训练（p <0.001）和验证（p = 0.010）队列中的病理LNM，以及测试队列中的临床LNM（p <0.001）相关。在预测病理LNM方面，术前LNM评分优于仅使用MRI可疑LN（曲线下面积为0.703与0.604，p = 0.004）。在所有队列中，术前LNM评分也与总体生存率相关（p <0.001）。我们的术前LNM评分与病理或临床LNM相关性显著，并且优于仅使用MRI可疑LN。©2023年，亚太肝病研究协会。

The abnormality of imaging finding of lymph node (LN) has demonstrated unsatisfactory diagnostic accuracy for pathologic lymph node metastasis (LNM). We aimed to develop and validate a simple scoring system predicting LNM in patients with intrahepatic cholangiocarcinoma (iCCA) prior to surgery based on MRI and clinical findings.We retrospectively enrolled consecutive patients who underwent surgical resection for treatment-naïve iCCA from six institutions between January 2009 and December 2015. Patients who underwent lymph node dissection (LND) were randomly assigned to the training and validation cohorts at a 2:1 ratio, an¹ìd pathologic LN status was evaluated. Patients who did not undergo LND were assigned to the test cohort, and clinical LN status was evaluated. Using MRI and clinical findings, a preoperative LNM score was developed in the training cohort and validated in the validation and test cohorts.The training, validation, and test cohorts included 102, 53, and 118 patients, respectively. The preoperative LNM score consisted of serum carcinoembryonic antigen and two MRI findings (suspicious LN and bile duct invasion). The preoperative LNM score was associated with pathologic LNM in training (p < 0.001) and validation (p = 0.010) cohorts and clinical LNM in test cohort (p < 0.001). The preoperative LNM score outperformed MRI-suspicious LN alone in predicting pathologic LNM (area under the curve, 0.703 vs. 0.604, p = 0.004). The preoperative LNM score was also associated with overall survival in all cohorts (p < 0.001).Our preoperative LNM score was significantly associated with pathologic or clinical LNM and outperformed MRI-suspicious LN alone.© 2023. Asian Pacific Association for the Study of the Liver.