Evolving Radiologic Approaches in Monitoring Hepatocellular Carcinoma After Locoregional Therapy

Abstract

Background: Hepatocellular carcinoma (HCC) represents a major global health challenge, particularly in regions with high prevalence of chronic liver disease. Locoregional therapies (LRTs), including transarterial chemoembolization (TACE), radiofrequency ablation (RFA), microwave ablation (MWA), and radiation segmentectomy, are widely adopted for patients with unresectable HCC. Accurate and timely radiologic assessment following LRT is critical for determining therapeutic efficacy, detecting residual or recurrent disease, and guiding subsequent management. This review aims to comprehensively explore the evolving radiologic strategies used to monitor hepatocellular carcinoma after locoregional therapy. Emphasis is placed on conventional imaging modalities such as contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), as well as advanced functional techniques including diffusion-weighted imaging (DWI), hepatobiliary phase imaging, and dynamic contrast enhancement. The role of structured interpretation systems like LI-RADS Treatment Response Algorithm (TRA) and modified RECIST (mRECIST) is also examined.