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Imaging post-stereotactic body radiation therapy responses for hepatocellular carcinoma: typical imaging patterns and pitfalls

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Abstract

Stereotactic body radiation therapy (SBRT) has increased utility in the management of hepatocellular carcinoma (HCC) ranging from local therapy in early-stage HCC not suitable for other focal therapies to end-stage HCC. As the indications for the use of SBRT in HCC expand, diagnostic imaging is being increasingly used to assess response to treatment. The imaging features of tumor response do not parallel those of other focal therapies such as radiofrequency ablation or trans-arterial chemoembolization that immediately devascularize the tumor. The tumor response to SBRT on imaging takes much longer and often shows gradual changes including the reduction of enhancement and size over several months. It is essential to recognize the typical imaging patterns of response, as well as the appearance of focal liver reaction in the non-target liver that can confound image interpretation. The timing of treatment response assessment imaging is fundamental to minimize the potential for false negative response. The purpose of this article is to review the variable post-SBRT imaging features of HCC and adjacent liver parenchyma and discuss the potential pitfalls of imaging evaluation after SBRT for HCC.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada

    Katerina Mastrocostas, Hyun-Jung Jang & Tae Kyoung Kim

  2. Laboratory Medicine Program, Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada

    Sandra Fischer

  3. Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Laura A. Dawson & Pablo Munoz-Schuffenegger

  4. Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada

    Gonzalo Sapisochin

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  1. Katerina Mastrocostas
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  2. Hyun-Jung Jang
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  3. Sandra Fischer
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  4. Laura A. Dawson
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  5. Pablo Munoz-Schuffenegger
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Correspondence to Tae Kyoung Kim.

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Mastrocostas, K., Jang, HJ., Fischer, S. et al. Imaging post-stereotactic body radiation therapy responses for hepatocellular carcinoma: typical imaging patterns and pitfalls. Abdom Radiol 44, 1795–1807 (2019). https://doi.org/10.1007/s00261-019-01901-y

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