Imaging in staging, treatment planning, and monitoring of hepatocellular carcinoma for local and locoregional therapies: consensus recommendations from EORTC and ESGAR

Osman Öcal^{1

2}, Christoph Johannes Zech^{3

4}, Maria Antonietta Bali^{4

5}, David Pasquier^{6

7

8}, Felix Mottaghy^{9

10}, Ingo Einspieler¹¹, Nikolaos Kartalis^{4

12}, Irene Bargellini¹³, Roberto Iezzi^{14

15}, Timm Denecke¹⁶, Wolfgang Gerhard Kunz^{6

17}, Bernhard Gebauer¹⁸, Henning Wege¹⁹, Roberto Cannella²⁰, Daniela Elena Oprea-Lager^{6

21}, Arndt Vogel^{22

23}, Bruno Sangro²⁴, Max Seidensticker^{6

17}; study group

Collaborators, Affiliations

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany. osman.oecal@med.uni-muenchen.de.
² Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium. osman.oecal@med.uni-muenchen.de.
³ Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
⁴ European Society of Gastrointestinal and Abdominal Radiology (ESGAR), Vienna, Austria.
⁵ Radiology Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
⁶ Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium.
⁷ Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.
⁸ CRIStAL, CNRS, Lille University, Lille, France.
⁹ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁰ Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany.
¹¹ Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
¹² Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
¹³ Diagnostic and Interventional Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.
¹⁴ Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia d'Urgenza e Interventistica, Roma, Italia.
¹⁵ Institute of Radiology, Catholic University, Rome, Italy.
¹⁶ Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
¹⁷ Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
¹⁸ Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany.
¹⁹ Cancer Center Esslingen, Klinikum Esslingen, Esslingen, Germany.
²⁰ Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
²¹ Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
²² Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada; Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
²³ Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
²⁴ Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain.

PMID: 40410331
DOI: 10.1007/s00330-025-11699-7

Imaging in staging, treatment planning, and monitoring of hepatocellular carcinoma for local and locoregional therapies: consensus recommendations from EORTC and ESGAR

Osman Öcal et al. Eur Radiol. 2025.

. 2025 May 23.

doi: 10.1007/s00330-025-11699-7. Online ahead of print.

Authors

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany. osman.oecal@med.uni-muenchen.de.
² Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium. osman.oecal@med.uni-muenchen.de.
³ Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
⁴ European Society of Gastrointestinal and Abdominal Radiology (ESGAR), Vienna, Austria.
⁵ Radiology Department, Institut Jules Bordet Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
⁶ Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium.
⁷ Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.
⁸ CRIStAL, CNRS, Lille University, Lille, France.
⁹ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁰ Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany.
¹¹ Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
¹² Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
¹³ Diagnostic and Interventional Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.
¹⁴ Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia d'Urgenza e Interventistica, Roma, Italia.
¹⁵ Institute of Radiology, Catholic University, Rome, Italy.
¹⁶ Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
¹⁷ Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
¹⁸ Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany.
¹⁹ Cancer Center Esslingen, Klinikum Esslingen, Esslingen, Germany.
²⁰ Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
²¹ Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
²² Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada; Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
²³ Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
²⁴ Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain.

PMID: 40410331
DOI: 10.1007/s00330-025-11699-7

Abstract

Background: Periinterventional imaging of patients with hepatocellular carcinoma (HCC) during local and locoregional therapies plays a crucial role in clinical outcome by guiding treatment allocation, planning, and application. However, there is a considerable variety in clinical routine in terms of timing, modality, and imaging protocols. This study aimed to guide the standardization of the imaging procedures for patients with HCC by conducting a Delphi consensus-finding survey.

Methods: A multidisciplinary, multinational survey was conducted to standardize the imaging of patients with HCC using the Delphi method.

Results: Under the guidance of the European Organisation for Research and Treatment of Cancer (EORTC) Imaging and Gastrointestinal Tract Cancer Groups and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the recommendations for imaging before, during, and after thermal ablation, transarterial chemoembolization, radioembolization, and stereotactic body radiation therapy were established.

Conclusion: This consensus protocol provides a foundational guide for imaging in the daily clinical management of HCC patients, as well as for prospective studies assessing local and locoregional therapies.

Key points: Question There are clear recommendations for the respective therapies/disease stages in HCC, but only to a limited extent for all-around imaging of local therapies. Findings This study conveyed a Delphi consensus-finding survey amongst European experts from multiple medical fields to standardize the periinterventional imaging of HCC patients. Clinical relevance These recommendations can guide both daily clinical practice and prospective trials focused on local and locoregional therapies.

Keywords: Ablation; Hepatocellular carcinoma; Imaging; SBRT; TACE.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Osman Öcal. Conflict of interest: The authors of this manuscript declare relationships with the following companies: R.C.: Support for attending meetings from Bracco and Bayer; research collaboration with Siemens Healthineers; co-funding by the European Union—FESR or FSE, PON Research and Innovation 2014-2020—DM 1062/2021. O.Ö. is a Junior Deputy Editor for European Radiology. N.K. is a member of the Scientific Editorial Board of European Radiology (section: Magnetic Resonance). As such, they did not participate in the selection or review processes for this article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Informed consent was not required due to the nature of the study. Ethical approval: Institutional Review Board approval was not required due to the nature of the study. Study subjects or cohorts overlap: Not applicable. Methodology: Multicenter study

References

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Imaging in staging, treatment planning, and monitoring of hepatocellular carcinoma for local and locoregional therapies: consensus recommendations from EORTC and ESGAR

Collaborators

Affiliations

Imaging in staging, treatment planning, and monitoring of hepatocellular carcinoma for local and locoregional therapies: consensus recommendations from EORTC and ESGAR

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

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