放射性分割治疗使用钇-90在早期肝细胞癌（HCC）的管理中发挥着新兴作用。然而，针对早期治疗后磁共振成像（MRI）用于评估治疗反应的价值尚不确定。我们评估了早期放射性分割治疗后获得的治疗反应标准对HCC患者的长期反应预测价值。 这项回顾性单中心研究纳入了接受放射性分割治疗前、早期和12个月后进行对比增强MRI的HCC患者。三名独立的放射科医生在放射性分割治疗前和随访1次后回顾图像，并根据mRECIST、LI-RADS治疗反应算法（TRA）和图像减法评估基于病变的治疗反应。终点是根据两位独立放射科医生的共识结果判断12个月时的治疗反应。根据第一次治疗后MRI计算了预测12个月完全缓解（CR）的诊断准确性。 纳入了80名患者（男/女60/20，平均年龄67.7岁），评估了80个HCC（中位数基线大小1.8 cm [IQR，1.4-2.9 cm]）。12个月时，74名患者被分类为CR（92.5%），5名患者为部分缓解（6.3%），1名患者为进展性疾病（1.2%）。对于所有读者，用于预测CR的诊断准确性在公正至良好之间，具有出色的阳性预测值（PPV）：mRECIST（3位读者之间的范围，准确性：0.763-0.825，PPV：0.966-1），LI-RADS TRA（准确性：0.700-0.825，PPV：0.983-1）和减法（准确性：0.775-0.825，PPV：0.967-1），标准之间的诊断准确性没有差异（p范围0.053至> 0.9）。 早期治疗后MRI上获取的mRECIST、LI-RADS TRA和减法对于预测放射性分割治疗后HCC患者的长期反应表现出类似的性能。 从放射性分割治疗后早期治疗后MRI提取的治疗反应评估可预测HCC患者的完全缓解，其PPV高（≥0.96）。• MRI上早期治疗反应评估可预测放射性分割治疗后HCC患者的反应，其诊断准确性公正至良好，具有出色的阳性预测值。• 对于预测HCC对放射性分割治疗的反应，mRECIST、LI-RADS和减法之间的诊断准确性没有差异。© 2023. 作者。

Radiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC.Patients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1st follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1st post-treatment MRI was calculated.Eighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4-2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763-0.825, PPV: 0.966-1), LI-RADS TRA (accuracy: 0.700-0.825, PPV: 0.983-1), and subtraction (accuracy: 0.775-0.825, PPV: 0.967-1), with no difference in accuracy between criteria (p range 0.053 to > 0.9).mRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy.Response assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96).• Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value. • There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.© 2023. The Author(s).