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Fig. 2 | BMC Cancer

Fig. 2

From: Optimal application of stereotactic body radiotherapy and radiofrequency ablation treatment for different multifocal hepatocellular carcinoma lesions in patients with Barcelona Clinic Liver Cancer stage A4–B1: a pilot study

Fig. 2

A case of complete tumor response and intrahepatic distal recurrence. (a,b) A 40 mm lesion in segment (S)7 was planned for SBRT, showing unenhanced CT and arterial phase (AP) of contrast-enhanced CT images, respectively. The lesion was partial hyperenhanced. (c) Grayscale ultrasound (US) image shows the lesion in S7 located adjacent to the diaphragm and hepatic vein. It was estimated that ablation would be risky because of its location. The lesion was well-defined and with a nodule-in-nodule appearance. (d) A dose distribution picture of SBRT treatment plan was generated. A total dose of 40 Gy (red isodose line) was delivered in 5 fractions. The central part received 55 Gy radiation. (e) An 11 mm lesion located in S5 was detected in the AP of the contrast-enhanced CT image. (f,g) Grayscale US and color Doppler flow image of the lesion. (h) Grayscale US image in the process of RFA. (i,j) Compared with unenhanced T1-weighted MR image (i), at the one-year follow-up, the SBRT-treated area considerably decreased and changed into totally hypoenhancement (j). (k,l) At the one-year follow-up, the RFA-treated area changed into hyperenhanced scars in both the unenhanced T1-weighted image (k) and the AP of Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid MRI (EOB-MRI) (l). (m,n) After 44.8 months’ follow-up, a new 10 mm lesion was detected in S4. In grayscale US (m), it appeared as slightly hyperechoic and poorly defined. In the AP of contrast-enhanced US (n), the lesion displayed hypervascularity. In the unenhanced CT(o) taken as a reference, the AP of the contrast-enhanced CT image (p) showed hyperenhancement. Red arrows in (a–c) and (e–p) indicate the location of the target lesion or post-treated area. Dark blue arrows in (b) and (d) show the approximate position of the S7 lesion. This case corresponds to the No. 1 patient shown in the tables

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