Assessing radiographic treatment response to hepatocellular carcinoma following locoregional therapy other than radiation therapy

For patients with HCC, the antitumor effect of locoregional therapy other than radiation therapy (eg, radiofrequency ablation, microwave ablation, cryoablation, percutaneous ethanol ablation, TACE, conventional TACE, DEB-TACE) is not always accurately reflected by conventional bidimensional tumor measurements on radiographic studies. The antitumor effect of such therapies is more accurately evaluated based on the American College of Radiology's LI-TR criteria. These criteria should be applied with caution in patients who receive locoregional therapy in combination with systemic therapy.

CT: computed tomography; DEB-TACE: drug-eluting bead transarterial chemoembolization; HCC: hepatocellular carcinoma; LI-RADS: Liver Imaging Reporting and Data System; LR-TR: LI-RADS treatment response; MRI: magnetic resonance imaging; TACE: transarterial chemoembolization.

* Examples of no mass-like enhancement include complete disappearance of the lesion, no lesional enhancement, small perilesional enhancement, or parenchymal perfusional changes without mass-like enhancement.

¶ If the clinician is unsure about choosing between two categories (ie, LR-TR viable or LR-TR equivocal; LR-TR nonviable or LR-TR equivocal), they should choose LR-TR equivocal.

Adapted from: Springer: Kielar A, Fowler KJ, Lewis S, et al. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY) 2018; 43:218.

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Assessing radiographic treatment response to hepatocellular carcinoma following locoregional therapy other than radiation therapy