MRI Assessment of Hepatocellular Carcinoma after Local-Regional Therapy: A Comprehensive Review

Mendiratta‐Lala, Mishal; Masch, William R.; Shampain, Kimberly L.; Zhang, Andrew; Jo, Alexandria; Moorman, Sarah E H; Aslam, Anum; Maturen, Katherine E.; Davenport, Matthew S.

doi:10.1148/rycan.2020190024

Cited by 30 publications

(34 citation statements)

References 51 publications

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“…Several HCC-specific radiological response classification systems have been developed, including the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and the LI-RADS-Treatment Response (LI-RADS-TR) [ 205 , 206 ]. Compared to conventional tumor response evaluation criteria, LI-RADS-TR and mRECIST focus on the presence of viable contrast-enhancing HCC tissue rather than changes in total tumor size [ 207 ]. The interpretation of radiologic findings after locoregional therapy may be challenging, due to the presence of treatment-induced changes in the peritumoral liver parenchyma, which vary among different therapies [ 207 ].…”

Section: Imaging Assessment Of Hcc Following Percutaneous Locoregiona...mentioning

confidence: 99%

“…Compared to conventional tumor response evaluation criteria, LI-RADS-TR and mRECIST focus on the presence of viable contrast-enhancing HCC tissue rather than changes in total tumor size [ 207 ]. The interpretation of radiologic findings after locoregional therapy may be challenging, due to the presence of treatment-induced changes in the peritumoral liver parenchyma, which vary among different therapies [ 207 ].…”

Section: Imaging Assessment Of Hcc Following Percutaneous Locoregiona...mentioning

confidence: 99%

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Current Imaging Diagnosis of Hepatocellular Carcinoma

Chartampilas

Rafailidis

Georgopoulou

et al. 2022

Cancers

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Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.

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Section: Imaging Assessment Of Hcc Following Percutaneous Locoregiona...mentioning

confidence: 99%

Section: Imaging Assessment Of Hcc Following Percutaneous Locoregiona...mentioning

confidence: 99%

Current Imaging Diagnosis of Hepatocellular Carcinoma

Chartampilas

Rafailidis

Georgopoulou

et al. 2022

Cancers

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“…After SBRT, APHE with or without “washout” can persist for up to a year, and even longer, but these imaging features gradually decrease over time[ 51 ] (Figure 6 ). Early post treatment, geographic APHE surrounding the treated tumor is a common finding and likely represents hyperemia; this eventually converts to progressive delayed phase geographic enhancement, likely secondary to radiation fibrosis, usually with associated findings of capsular retraction and peripheral intrahepatic biliary dilatation[ 52 ].…”

Section: Expected Post Treatment Imaging Appearancementioning

confidence: 99%

Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions

Aslam

Gian

Kambadakone

et al. 2020

WJH

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Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, with rising clinical and economic burden as incidence increases. There are a multitude of evolving treatment options, including locoregional therapies which can be used alone, in combination with each other, or in combination with systemic therapy. These treatment options have shown to be effective in achieving remission, controlling tumor progression, improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients. Following locoregional therapy (LRT), it is crucial to provide treatment response assessment to guide management and liver transplant candidacy. Therefore, Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of HCC following LRT. LI-RADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment. In this review, we provide an overview of different locoregional therapies for HCC, describe the expected post treatment imaging appearance following treatment, and review the LI-RADS TRA with guidance for its application in clinical practice. Unique to other publications, we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.

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“…1). 29 Importantly, persistent central arterial hyperenhancement can be seen longer than 3 months in tumors treated by TARE, with progressive decrease and eventual lack of enhancement over time. Imaging features suggestive of residual tumor after TARE include new or enlarging nodular or mass‐like APHE within or around the treated tumor and growth over time, particularly more than 6 months after treatment 29 …”

Section: Radiographic Evaluation After Liver Radiation Therapymentioning

confidence: 99%

Radiation Therapies for the Treatment of Hepatocellular Carcinoma

Parikh

Cuneo

Mendiratta‐Lala

2021

Clinical Liver Disease

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Hepatocellular carcinoma (HCC) is a leading cause of worldwide cancer mortality. 1 There is emerging favorable evidence behind the efficacy of radiation therapy in the form of transarterial radioembolization (TARE) and external beam radiation therapy for patients with HCC. Herein, we review the evidence for the use of these therapies, the assessment of treatment response, and the future directions needed for wider application of radiation therapy for the treatment of HCC. TareTARE with yttrium-90-embedded glass or resin microspheres was given compassionate use approval by the US Food and Drug Administration in 1999, and with refinement in technique and patient selection, it has become an increasingly used form of locoregional therapy for HCC. 2,3 The principle behind TARE infusion is intra-arterial delivery of high-dose ionizing radiation into the tumor bed via the hepatic artery, with continuous radiation exposure as the yttrium-90 decays. TARE is typically conducted in a two-step process, with a 99m technecium-labeled macroaggregated albumin mapping study prior to treatment to evaluate possible deposition of microspheres in extrahepatic sites, although patients with early-stage HCC (T1 or T2) may be able to avoid the mapping procedure. 4 The efficacy of TARE has been evaluated across multiple stages of HCC (Table 1). In early-stage HCC, "radiation

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MRI Assessment of Hepatocellular Carcinoma after Local-Regional Therapy: A Comprehensive Review

Cited by 30 publications

References 51 publications

Current Imaging Diagnosis of Hepatocellular Carcinoma

Current Imaging Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions

Radiation Therapies for the Treatment of Hepatocellular Carcinoma

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