Detection, accurate staging, and optimal management of biliary malignancies continue to present a significant challenge. This article reviews the current capabilities and roles of the various imaging modalities available in clinical practice, followed by a discussion of their integrated use at initial presentation, particularly with respect to potential surgical management of central hilar and intrahepatic cholangiocarcinoma. The main imaging modalities include MRI, CT, ultrasound, positron emission tomography, and conventional cholangiography. Alternative and emerging imaging methods, problematic diagnostic imaging issues, and other rarer bile duct malignancies are also briefly discussed.