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

Figure 6 Fifty-eight-year old male presenting 3 mo post transarterial chemoembolization for follow up of a 7. 2 cm LR 5 hepatocellular carcinoma. Persistent thick nodular peripheral arterial phase hyperenhancement (APHE) of the treated tumor (A) with “washout” on portal venous phase (B), LR-TR Viable. This lesion was subsequently treated with stereotactic body radiotherapy (SBRT). Three months post SBRT there is persistent APHE on arterial phase (C) and “washout” on portal venous phase (D), with no change in size, LR-TR Viable or Equivocal. Six months post SBRT, there is decreasing size of the tumor to 6.3 cm with decreasing APHE and increasing necrosis, albeit persistent APHE (E) and “washout” (F), LR-TR Equivocal. Fifteen months post SBRT, further decrease in size to 5.1 cm, now with minimal residual APHE (G) and “washout” (H), LR-TR Nonviable.