BOLD MRI and FMISO PET for the Assessment of Hypoxic Tumor Microenvironment in Patients with Oligometastatic Liver Cancer Undergoing Yttirum-90 Selective Internal Radiation Therapy

Inclusion Criteria:

* Age \>= 18 years
* Established HCC diagnosis, unilobar or bilobar disease
* At least 1 tumor \>= 3 cm
* Oligometastatic disease
* Barcelona Clinic Liver Cancer (BCLC) stage A, B or C
* Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (Karnofsky \>= 60%)
* Life expectancy \> 12 weeks as determined by the Investigator
* The effects of Y90 Radioembolization on the developing human fetus are unknown. For this reason, female of child-bearing potential (FCBP) must have a negative serum or urine pregnancy test prior to starting therapy
* FCBP and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
* A female of childbearing potential (FCBP) is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months

Exclusion Criteria:

* Patients who are definite transplant candidates
* Concurrent second malignancy outside of the liver
* Infiltrative liver tumor
* Previous liver-directed therapy to targeted tumors
* BCLC stage D
* Bilirubin \> 2 mg/dL for lobar treatment and bilirubin \> 3 mg/dL for segmental or bi-segmental Y90-SIRT
* Albumin \< 3 g/dL
* Projected lung dose of \> 30 Gy in a single session to the liver after prospective treatment planning
* Body mass index (BMI) \> 40