MRI after Interventional Therapy of Hepatocellular Carcinoma: Typical Changes over Time

Interventional therapies for hepatocellular carcinoma (HCC) include various methods such as transarterial chemoembolization (TACE), radiofrequency and microwave ablation (RFA, MWA), selective internal radiotherapy (SIRT), and stereotactic body radiation therapy (SBRT). Imaging follow-up using magnetic resonance imaging (MRI) is essential for the early detection of recurrence, but requires profound knowledge of therapy-related imaging changes.

A structured PubMed literature search covering the period from 2000 to 2025 was conducted using the keywords "hepatocellular carcinoma," "magnetic resonance imaging," "thermal ablation," "transarterial chemoembolization," "transarterial radioembolization," "stereotactic body radiotherapy," and "treatment response." In addition, the study incorporated current national and international guidelines, as well as institutional clinical experience.

Post-interventional imaging changes on MRI vary depending on the therapeutic approach applied. Typical morphological changes are observed immediately after thermoablation and TACE, whereas therapeutic effects of SIRT and SBRT become clearly evident only after weeks to months. Profound knowledge of standardized evaluation systems such as mRECIST, EASL, and LI-RADS-TR is crucial to ensure a precise and structured assessment of therapeutic response.

Knowledge of specific MRI findings and standardized assessment systems is essential for structured follow-up of hepatocellular carcinoma after interventional therapy. Limitations arise from the heterogeneity of imaging findings, variable temporal patterns, and potential influences of combination therapies. Systemic therapies were not considered, restricting generalizability.

· Magnetic resonance imaging is essential for assessing treatment response and for the early detection of recurrence after interventional therapy of hepatocellular carcinoma.. · Morphological changes after therapy are procedure-dependent and show marked differences over time: SIRT and SBRT demonstrate delayed changes, whereas TACE and thermal ablation present immediate effects.. · Standardized classification systems (mRECIST, EASL, LI-RADS-TR) provide a structured and reproducible framework for evaluating treatment response.. · Knowledge of characteristic imaging findings and potential pitfalls is crucial to reliably differentiate between residual tumor, recurrence, and therapy-induced changes.. · This review contributes to the current body of knowledge by systematically consolidating available evidence and presenting it in a practice-oriented manner in the context of MRI follow-up imaging..

· Kübler J, Ashkar A, Winkelmann MT et al. MRI after Interventional Therapy of Hepatocellular Carcinoma: Typical Changes over Time. Rofo 2025; DOI 10.1055/a-2724-6488.