Temporal evolution of the LI-RADS radiation treatment response assessment on multiphase CT/MRI in patients undergoing selective internal radiation therapy for hepatocellular carcinoma - Scorecard - MDSpire
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Temporal evolution of the LI-RADS radiation treatment response assessment on multiphase CT/MRI in patients undergoing selective internal radiation therapy for hepatocellular carcinoma
Clinical Scorecard: Progression of LI-RADS Assessment for Radiation Treatment Response on Multiphase CT/MRI in Patients Receiving Selective Internal Radiation Therapy for Hepatocellular Carcinoma
At a Glance
Category
Detail
Condition
Hepatocellular carcinoma (HCC)
Key Mechanisms
Selective internal radiation therapy (SIRT) with Yttrium-90 induces gradual tumor response via DNA damage, free radical formation, and activation of proinflammatory and reparative pathways
Target Population
Adult patients (≥18 years) with HCC, BCLC stage A-C without extrahepatic metastases, no prior HCC treatment, and suitable liver function
Care Setting
Multidisciplinary liver cancer centers performing locoregional therapies with imaging follow-up
Key Highlights
SIRT is an emerging locoregional therapy for HCC with demonstrated clinical benefits and safety across early to intermediate stages
The 2024 LI-RADS CT/MRI Radiation Treatment Response Assessment (TRA) algorithm introduces a specific framework for evaluating radiation-based therapies including a new LR-TR nonprogressing category
Tumor response after SIRT evolves gradually over months, necessitating dynamic imaging evaluation at 3–6 months post-treatment for accurate assessment
Guideline-Based Recommendations
Diagnosis
Use LI-RADS version 2018 diagnostic algorithm for initial HCC diagnosis
Perform multiphase contrast-enhanced CT/MRI within 2 months before SIRT
Apply LI-RADS CT/MRI Radiation TRA version 2024 for treatment response assessment at 3–6 months post-SIRT
Management
Select patients for SIRT based on tumor burden (≤70% liver volume, single tumor ≤8 cm), liver function (Child–Pugh A or B7), performance status (ECOG 0 or 1), and patient preference
Conduct planning angiography with Tc-99m MAA mapping prior to SIRT for dosimetry and treatment planning
Administer Y90 glass or resin microspheres with personalized dosimetry sparing at least 30% of functional liver volume and limiting lung dose to 30 Gy
Monitoring & Follow-up
Perform multiphase CT/MRI at 3–6 months post-SIRT to evaluate treatment response using LI-RADS Radiation TRA categories
Assess imaging features including lesion size, masslike enhancement, lesion disappearance, perilesional enhancement, and ancillary MRI features favoring viability
Use dynamic and longitudinal imaging evaluation to identify treatment failure or progression
Risks
Avoid SIRT in patients with main portal vein tumor thrombosis or extensive liver involvement beyond criteria
Monitor for potential radiation-induced liver injury by sparing adequate functional liver volume and limiting lung radiation dose
Patient & Prescribing Data
Patients with HCC eligible for SIRT without prior treatment and adequate liver function
SIRT is administered selectively via segmental or lobar arteries using Y90 microspheres with personalized dosimetry; treatment response is gradual and requires imaging follow-up for accurate assessment
Clinical Best Practices
Use multidisciplinary tumor board discussions to select appropriate candidates for SIRT
Follow standardized imaging protocols per LI-RADS minimum technique specifications for CT and MRI
Ensure blinded, independent radiologist review of imaging to improve interobserver agreement in treatment response assessment
Incorporate the LR-TR nonprogressing category to better characterize stable or decreasing masslike enhancement lesions post-radiation therapy
Avoid retreatment within 12 months post-SIRT unless clear evidence of progression
