Figure 11g:

Evolution of imaging findings after stereotactic body radiation therapy (SBRT) with recurrent disease in a 65-year-old woman with hepatocellular carcinoma (HCC) (arrow). (a) Pretreatment MR image shows a 5.4-cm LR-5/OPTN 5× HCC in segment 8 of liver with arterial phase hyperenhancement (APHE), “washout”and “capsule” (b). (c) Three months after SBRT, the treated HCC measures 2.6 cm with persistent APHE and “washout” (d) (mRECIST PR, LR-TR nonviable). (e) Nine months after SBRT, the treated HCC measures 1.3 cm with persistent but decreased intensity of APHE and “washout” (f) (mRECIST PR, LR-TR nonviable). (g) One year after SBRT, the treated tumor begins to increase in size, now measuring 4.8 cm with increased intensity of APHE, “washout” and “capsule” (h). These findings are compatible with local tumor progression and biopsy proven (mRECIST PD, LR-TR viable). (c, e) Evolution of radiation changes in the surrounding parenchyma shows early geographic arterial phase enhancement. (f) Over time, there is conversion to delayed phase geographic parenchymal enhancement and progressive volume loss along the surface of the liver, secondary to fibtrosis. LR = LI-RADS, mRECIST = modified Response Evaluation Criteria for Solid Tumors, OPTN = Organ Procurement and Transplantation Network, PD = progressive disease, PR = partial response, SBRT = stereotactic body radiation therapy, TR = treatment response.