Figure 10e:

Imaging findings after stereotactic body radiation therapy. Axial images from a 59-year-old man with hepatocellular carcinoma (HCC) (arrow). (a) Pretreatment MR image demonstrates a 2.9-cm LR-5/OPTN 5B HCC in segment 8 of liver with arterial phase hyperenhancement (APHE), “washout” and “capsule” (b). (c) Three months after SBRT, the treated HCC measures 2.4 cm with persistent APHE and “washout” (d) (mRECIST SD, LR TR nonviable). (e) Six months after SBRT, the treated lesion measures 1.3 cm with persistent APHE and “washout” (f) (mRECIST PR, LR-TR nonviable). (g) One year after SBRT, the treated tumor measures 0.8 cm with persistent APHE and “washout” (h) (mRECIST PR, LR-TR nonviable). (i, j) Two years after SBRT the tumor is no longer seen (mRECIST CR, LR-TR nonviable). The surrounding parenchyma undergoes an evolution of radiation changes with early geographic arterial phase enhancement which normalized at portal venous (PV) phase of imaging. Over time, there is conversion to delayed phase geographic parenchymal enhancement, and progressive volume loss along the surface of the liver, secondary to fibrosis. CR = complete response, LR = LI-RADS, mRECIST = modified Response Evaluation Criteria for Solid Tumors, OPTN = Organ Procurement and Transplantation Network, PR = partial response, SBRT = stereotactic body radiation therapy, SD = stable disease, TR = treatment response.