Hepatocellular carcinoma after locoregional therapy: Magnetic resonance imaging findings in falsely negative exams

Figure 1 Treatment-related signal alterations on T1-weighted images. A 59-year-old man with HCV cirrhosis and a segment V LI-RADS 5B lesion measuring up to 3.6 cm. Fat-saturated T1-weighted precontrast (A) and arterial-phase (B) images demonstrate a 3.6 cm enhancing focus of viable tumor (B, arrow) within an area previously treated with TACE. Mass could not be visualized upon selective angiography so repeat TACE was not performed. Non-contrast CT from a radiofrequency ablation procedure (C) demonstrates an electrode positioned within the tumor. One month later a fat-saturated T1-weighted precontrast image (D) demonstrates peripheral high signal related to hemorrhage from coagulative necrosis (D, arrow). LI-RADS: Liver imaging reporting and data system; TACE: Transarterial chemoembolization; HCV: Hepatitis C virus.