http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100319/-/DC1.

Aim The predictors for the development of hepatocellular carcinoma (HCC) after direct‐acting antiviral (DAA) treatment were investigated. Methods A total of 1174 patients with chronic hepatitis C virus infection were treated with DAA therapy (sofosbuvir and ledipasvir [n = 615], sofosbuvir and ribavirin [n = 380], and daclatasvir and asunaprevir [n = 179]) and achieved sustained virologic response (SVR). The HCC development rate and the factors that might contribute to the development of HCC after the end of DAA treatment were analyzed. Results During the median observation period of 537 days, HCC developed in 33 cases. The incidence of HCC was 1.9%, 3.2%, and 4.1% at 1, 1.5, and 2 years after the end of DAA therapy, respectively. Multivariate analysis with pre‐ and post‐treatment factors identified the Fibrosis‐4 (FIB‐4) index (hazard ratio [HR] = 1.09; 95% confidence interval [CI], 1.021–1.178; P = 0.011) and post‐treatment α‐fetoprotein (AFP) (HR = 1.11; 95% CI, 1.054–1.172; P < 0.001) as independent factors that contributed to the development of HCC after DAA therapy. Using these identified parameters, a new scoring system (0 to 2 points) was established. Patients in the high‐score group (2 points) could be identified as having a significantly higher risk of HCC development, and the respective 1‐ and 2‐year cumulative incidence rates of HCC were 6.1% and 14.4%. Conclusions A high FIB‐4 index and a high post‐treatment AFP at the end of DAA treatment were the independent predictors for developing HCC after DAA treatment. For patients with these risk factors, extra attention to the possibility of HCC development is needed.

Splenic elasticity determined with RTE is the most closely associated parameter for evaluating HVPG and is useful as a clinical marker of portal hypertension and a predictive marker of gastroesophageal varices.

Percutaneous RFA with artificial pleural effusion and/or artificial ascites was a safe and useful treatment that resulted in good local control of HCC.

The indications for TACE-RFA may be expanding to BCLC-B HCC. For patients with disease classified as substages B1 and B2, TACE-RFA may be a better treatment modality than TACE alone.