Integrated Imaging Strategy to Phenotype Progression of Liver Tumors During and After Chemoembolization

* INCLUSION CRITERIA:
* Patients must have confirmed inoperable primary hepatic malignancy or hepatic dominant metastatic - neoplastic disease evidenced by histology or cytology, or characteristic enhancement pattern on CT or MRI together with an abnormal serum alpha-fetoprotein \>200mg/dl in the case of hepatocellular carcinoma.
* Patients with hepatocellular carcinoma should conform to intermediate stage disease according to the BCLC(16) staging system (Stage A4 or B) and be otherwise eligible to receive TACE treatment.
* Patients must have had no chemotherapy or radiotherapy to the liver therapy for, their malignancy for at least 2 weeks (or until response can be adequately assessed) prior to treatment and must have recovered from all clinically significant side effects of therapeutic and diagnostic interventions.
* Serum creatinine less than or equal to 2.0 mg/dl unless the measured creatinine clearance is greater than 60ml/min
* Age greater than or equal to18 years
* Ability of subject to understand and willingness to sign a written informed consent document
* Patient must be able to lie still for the procedure
* ECOG status less than or equal to 2
* In addition, for patients receiving TACE outside NIH:

  * Patient must have physician willing to collaborate with NIH PI by providing required medical record and digital MR/ CT scan documentation pre and post TACE procedure.
  * Patient must be willing to sign an Authorization for the Release of Medical Information form

EXCLUSION CRITERIA:

* Patients who have received prior TACE treatment
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to misonidazole or other agents used in study.
* Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
* Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
* Patients of childbearing age must not be pregnant. The effects of \[(18)F\]FMISO on the developing human fetus are unknown. Pregnancy is a contraindication for TACE.