Figure 8h:

Equivocal and recurrent disease after transarterial radioembolization (TARE) in a 62-year-old woman. (a) Pretreatment axial arterial phase MR image shows a 4.8-cm LI-RADS 5/OPTN 5B hepatocellular carcinoma (HCC) (arrow) with arterial phase hyperenhancement (APHE) and washout (b). (c) Three months after TARE, the tumor is overall smaller in size with a 2.2-cm area of persistent APHE within the treated tumor (arrow), which demonstrates persistent delayed phase enhancement (arrow in d) (mRECIST PR, LR TR equivocal). (e) Five months after TARE, the tumor continues to regress in size, with the previously seen nodular arterial enhancing area measuring 1.6 cm (arrow), but with new “washout” (arrow in f) (mRECIST PR, LR TR equivocal). (g) Eight months after TARE, the treatment cavity itself is unchanged in size; however, there is now an increasing size of the enhancing tumor, measuring 2.6 cm (arrow), with “washout” (arrow) compatible with recurrent HCC (mRECIST PD, LR TR viable). An additional new area of the tumor is seen (arrowhead). LR = LI-RADS, mRECIST = modified Response Evaluation Criteria for Solid Tumors, OPTN = Organ Procurement and Transplantation Network, PD = progressive disease, PV = portal venous, TR = treatment response.