Magnetic resonance imaging findings after stereotactic body radiation therapy for hepatocellular carcinoma - a scoping literature review.

Authors

Caglayan Lara, Gkika Eleni, Péporté Anne, Stocker Daniel, Ghafoor Soleen

Published in

Clinical and translational radiation oncology. Volume 60. Pages 101227. Epub Jul 06, 2026.

Abstract

Stereotactic body radiotherapy (SBRT) is an established locoregional treatment option for hepatocellular carcinoma (HCC). However, post-treatment imaging remains challenging because tumor response and focal liver reaction (FLR), defined as radiation-related alterations of the adjacent liver parenchyma, may both evolve gradually and mimic viable or recurrent tumor. We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, and manual reference screening were used to identify studies published between January 2012 and February 2025 that evaluated MRI findings after SBRT for HCC. Studies were eligible if they reported MRI-based post-treatment outcomes after stereotactic, image-guided, highly conformal external-beam radiotherapy delivered in a limited number of fractions with ablative intent. Studies evaluating non-SBRT regimens, non-MRI imaging modalities, theoretical modeling approaches, reviews, and case reports were excluded. Eight studies met the inclusion criteria. Overall, MRI findings after SBRT demonstrated a delayed and time-dependent pattern rather than immediate tumor regression. In responding lesions, arterial phase hyperenhancement (APHE) and washout commonly decreased over time or evolved toward delayed enhancement or non-enhancement. T2-weighted and diffusion-weighted imaging (DWI) signal intensity tended to decline, whereas apparent diffusion coefficient (ADC) values increased. FLR was frequently observed and included perilesional enhancement, hepatobiliary phase hypointensity, capsular retraction, and dose-related parenchymal changes on gadoxetic acid-enhanced MRI. Response assessment after SBRT should therefore rely on serial multiparametric MRI rather than early arterial enhancement alone. Persistent enhancement shortly after treatment should not automatically be interpreted as treatment failure, and FLR remains an important source of diagnostic uncertainty. Prospective studies are needed to standardize MRI protocols, follow-up intervals, and response assessment criteria in this setting.

PMID:
42471954
Bibliographic data and abstract were imported from PubMed on 19 Jul 2026.

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