"Hepatocellular carcinomas that are not amenable to definitive therapy with thermal ablation or resection can be treated with trans-arterial radioembolisation (TARE). The end goal may be palliation or downstaging to meet liver transplantation criteria, depending on the situation."
"Sometimes on the initial (1 month) follow up scan, the treated lesion is completely non-enhancing (although the adjacent liver often shows post-radiation arterial phase enhancement) and this is compatible with a successful treatment response. This is a less common appearance after therapy."
"new or increasing DWI hyperintensity and ADC hypointensity in a suspicious area can be helpful to confirm."
"Post-TARE evaluation is typically performed with MRI. Notable, the evolution of the treatment cavity is different than that with TACE, which can be confusing for radiologists who are unfamiliar with a liver-directed therapy that has less of an embolic component and relies on the relatively slow effects of radiation."
"EASL and mRECIST measurements may be misleading for evaluating post-TARE change and are not typically used."
Expected headings
"Expected evolution of the treatment zone"
"Findings suspicious for new or recurrent tumour in the treatment zone"
"It is often the case that on the 1 and 3 month follow up exams, the treated lesion is unchanged in size (or even slightly increased in size) and peripheral irregular (or even nodular) enhancement may persist for months (pseudoprogression). Typically the treatment cavity slowly decreases in size over time. Often, 1 and 3 month follow ups have an "equivocal" appearance and only at around 6 months can one make a more confident assessment whether the therapy has been effective."
"LR-TR viable: masslike enhancement, new or increased over time"