fig3

Figure 3. A 67-year-old male with hepatitis B cirrhosis presents with LR M observation (A). Biopsy revealed poorly differentiated HCC. After a multidisciplinary discussion, a decision was made to treat with the combination of TACE + SBRT. One month after TACE (B), there is no residual intralesional enhancement with smooth perilesional enhancement from the 2 o’clock to 7 o’clock position, although there is mild irregularity along the anterior margin, LR-TR Equivocal. SBRT was then performed, and 3 months after SBRT, there was no residual enhancement and there was a circumferential smooth rim of perilesional enhancement, LR-TR Nonviable. This was re-treated with TACE after a multidisciplinary discussion. 1-month post repeat TACE, there is no residual enhancement of the nodular area of recurrence, LR-TR Nonviable (E). 3 months post-repeat TACE and 18 months post initial SBRT, there is a new nodular area of enhancement along the 5 o’clock margin, LR-TR Viable.