Fig. 3

A case of progressive tumor disease and local tumor progression. (a,b) RFA was planned for an 11 mm lesion in segment (S)6, showing unenhanced T1-weighted image and AP of EOB-MRI, respectively. The lesion was hyperenhanced. (c,d) A 32 mm lesion located in S8 was visible in both the T1-weighted image (c) and the AP of the EOB-MR image (d). Because of blind areas hidden in the lung gas, RFA treatment was impossible. (e) A dose distribution picture of SBRT treatment plan was generated. As this lesion was located adjacent to the gastrointestinal tract, radiotherapy with mild hypofractionation was performed. The total dose of 42Gy (red isodose line) was delivered in 14 fractions. The central part received 60 Gy radiation. (f,g) Compared with the unenhanced T1-weighted MR image (f), at the one-year follow-up, the SBRT-treated area changed to isoenhancement (g). There was a slight liver deformation caused by radiation irritation due to SBRT treatment. (h,i) About one month after RFA treatment, in the unenhanced T1-weighted image (h) and the AP of the EOB-MR image (i), the ablation area showed scars from treatment but no appearance of recurrence. (h–k) However, a T1-weighted image was taken (h) as a reference at the 4 months’ follow-up. A hyperenhanced area, just adjacent to the initial ablated area (thick arrow, hyperenhanced scars of ablated trace), was found in the AP of the EOB-MRI (k). The local recurrence was repeatedly treated by RFA. (l,m) Two months after the second RFA treatment, the ablated area appeared as hyperenhanced scars in both the unenhanced T1-weighted image (l) and the AP of the EOB-MRI (m). Thin arrows in (a–d) and (f–m) indicate the location of the target lesion or post-treated area. This case corresponds to the No. 12 patient shown in the three tables