fig5

Figure 5. 69-year-old with alcohol cirrhosis presents with LR 5 HCC (A). 3 months post-SBRT there is central necrosis with persistent thick peripheral APHE (B). There is also extensive peri-tumoral parenchymal APHE related to radiation changes. 6 (C), 9 (D) and 12 (E) months post-SBRT there is continued decrease in size of the treated tumor with persistent but decreasing thick peripheral rim enhancement. The extensive surrounding parenchymal geographic APHE is maximal at 6 months and then decreases. It eventually converts to delayed phase enhancement, compatible with radiation fibrosis (F). Based on the current LI-RADS v2018 TRA, this tumor would be categorized as LR-TR equivocal at all times points, however, the one year of stability with absence of progression is reassuring that the imaging features are expected post-SBRT findings with no clinically significant viable tumor. In future iterations of the LI-RADS TRA, this would be categorized as LR-TR nonprogressing at all timepoints.