742 - Comprehensive Imaging Assessment Review Post-Yttrium-90 Transarterial Radioembolization Therapy for Hepatocellular Carcinoma

Monday, April 13, 2026

4:57 PM - 5:03 PM ET

Abstract Presenter(s)

Arsalan Nadeem, MBBS (he/him/his)

Postdoctoral Research Fellow
Northwestern University, United States

Author/Co-author(s)

SA

Saad Abu Zahra, MD

Post-Doctoral Scholar
Northwestern University, United States
AB

Amir Borhani, MD

Attending Physician
Northwestern University, United States
FM

Frank H. Miller, MD

Professor of Radiology
Northwestern University Feinberg School of Medicine, United States
AG

Andrew C. Gordon, MD, PhD (he/him/his)

Assistant Professor
Feinberg School of Medicine, United States
Robert J. Lewandowski, MD, FSIR

Professor of Radiology, Medicine and Surgery
Northwestern University, Dept. of Radiology, IR section, United States

Learning Objectives:

Review evolving Yttrium-90 (Y90) transarterial radioembolization (TARE) treatment approaches based on clinical indication and radiation dosimetry.

Describe expected imaging findings following each TARE approach.

Discuss response assessment criteria and timelines of post-treatment evolution.

Background: Imaging plays a central role in evaluating treatment effect of Y-90 TARE for hepatocellular carcinoma (HCC), distinguishing expected post-treatment changes from viable tumor, and informing ongoing management. A systematic understanding of imaging appearance across modalities and timepoints is essential for accurate response assessment {1}. This exhibit offers an image-rich overview of post-TARE imaging findings and response criteria, providing practical guidance for accurate interpretation and clinical decision-making.

Clinical Findings/Procedure Details: Overview of Y90 TARE Approaches

Radiation Segmentectomy

Lobar TARE (Palliation)

Radiation Lobectomy

Modified Radiation Lobectomy

Imaging Modalities and Protocols of Treated HCC

Contrast-enhanced cross-sectional imaging:
a. Multiphase CT
b. MRI +/- hepatobiliary contrast agents
c. Contrast-enhanced Ultrasound

Role of diffusion-weighted imaging

Timing of assessment and follow-up

Post-TARE Imaging Appearance

Size changes
a. Time to response

Tumor necrosis
a. Lack of tumor enhancement
b. Time to tumor response, by treatment approach

Rim enhancement
a. Thin peripheral rim representing inflammatory reaction and fibrous tissue
b. Nodular enhancement
i. Viability assessed through ancillary findings

Edema and inflammation
a. Geographic wedge-shaped area of hyperenhancement along vascular distribution of treatment
b. Transient perfusion alterations, should not be confused with infiltrative tumor

Capsular retraction
a. Normal finding resulting from necrosis, fibrosis, and scarring

Tumor Response Assessment

Size:
a. Response Evaluation Criteria in Solid Tumors (RECIST)
b. World Health Organization (WHO) criteria

Enhancement:
a. modified RECIST
b. European Association for the Study of the Liver (EASL) criteria

Serum tumor marker correlation

CT/MRI Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Assessment (TRA) algorithm (version – 2024)

Conclusion and/or Teaching Points: Accurate interpretation of post-TARE imaging is critical for evaluating treatment response and guiding management. Using tumor response assessment criteria within a structured, timeline-driven approach ensures consistent and reliable assessment.