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

  • Katerina Mastrocostas
  • Hyun-Jung Jang
  • Sandra Fischer
  • Laura A. Dawson
  • Pablo Munoz-Schuffenegger
  • Gonzalo Sapisochin
  • Tae Kyoung KimEmail author


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.


Hepatocellular carcinoma Stereotactic body radiation therapy Imaging Treatment response CT MRI 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not applicable.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Katerina Mastrocostas
    • 1
  • Hyun-Jung Jang
    • 1
  • Sandra Fischer
    • 2
  • Laura A. Dawson
    • 3
  • Pablo Munoz-Schuffenegger
    • 3
  • Gonzalo Sapisochin
    • 4
  • Tae Kyoung Kim
    • 1
    Email author
  1. 1.Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College HospitalUniversity of TorontoTorontoCanada
  2. 2.Laboratory Medicine Program, Department of Pathology, University Health NetworkUniversity of TorontoTorontoCanada
  3. 3.Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoCanada
  4. 4.Multi Organ Transplant Program, Department of Surgery, Toronto General HospitalUniversity of TorontoTorontoCanada

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