Sequential Hemodynamic Change in Hepatocellular Carcinoma and Dysplastic Nodules
CT Angiography and Pathologic Correlation
Tsuyoshi Tajima1,
Hiroshi Honda1,
Kenichi Taguchi2,
Yoshiki Asayama2,
Toshirou Kuroiwa1,
Kengo Yoshimitsu1,
Hiroyuki Irie1,
Hitoshi Aibe1,
Mitsuo Shimada3 and
Kouji Masuda1
1
Department of Radiology, Faculty of Medicine, Kyushu University, 3-1-1
Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
2
Department of Pathology II, Faculty of Medicine, Kyushu University, Fukuoka,
812-8582, Japan.
3
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka,
812-8582, Japan.
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Fig. 1A. —67-year-old man with low-grade dysplastic nodules in right
hepatic lobe. Lesion-to-liver vascular ratios were as follows: for larger
nodule, cumulative artery ratio = 0.88, hepatic artery ratio = 0.7, portal
vein ratio = 0.82; for smaller nodule, cumulative artery ratio = 1.71, hepatic
artery ratio = 1.14, portal vein ratio = 0.84. CT hepatic arteriogram shows
1.9-cm and 2.4-cm hypoattenuating masses located in right lobe
(arrows).
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Fig. 1B. —67-year-old man with low-grade dysplastic nodules in right
hepatic lobe. Lesion-to-liver vascular ratios were as follows: for larger
nodule, cumulative artery ratio = 0.88, hepatic artery ratio = 0.7, portal
vein ratio = 0.82; for smaller nodule, cumulative artery ratio = 1.71, hepatic
artery ratio = 1.14, portal vein ratio = 0.84. CT scan obtained during
arterial portography shows both lesions seen in A are isoattenuating
compared with surrounding hepatic parenchyma. On basis of enhancement patterns
of CT hepatic arteriography and CT during arterioportography, both are
classified as group 2.
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Fig. 1C. —67-year-old man with low-grade dysplastic nodules in right
hepatic lobe. Lesion-to-liver vascular ratios were as follows: for larger
nodule, cumulative artery ratio = 0.88, hepatic artery ratio = 0.7, portal
vein ratio = 0.82; for smaller nodule, cumulative artery ratio = 1.71, hepatic
artery ratio = 1.14, portal vein ratio = 0.84. Photomicrograph of histologic
specimen of portal triad in larger nodule. Normal preexisting hepatic artery
and portal vein can be seen. A = preexisting hepatic artery, P = portal vein.
(H and E, x 130)
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Fig. 2A. —69-year-old man with high-grade dysplastic nodule and
moderately differentiated hepatocellular carcinoma in right hepatic lobe.
Lesion-to-liver vascular ratios were as follows: for smaller nodule,
cumulative artery ratio = 1.42, hepatic artery ratio = 0, portal vein ratio =
0; for larger nodule, cumulative artery ratio = 1.10, hepatic artery ratio =
0.80, portal vein ratio = 1.17. CT hepatic arteriogram shows 1.7-cm
hyperattenuating mass (solid arrow) and 2.6-cm hypoattenuating mass
(open arrow) in right lobe.
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Fig. 2B. —69-year-old man with high-grade dysplastic nodule and
moderately differentiated hepatocellular carcinoma in right hepatic lobe.
Lesion-to-liver vascular ratios were as follows: for smaller nodule,
cumulative artery ratio = 1.42, hepatic artery ratio = 0, portal vein ratio =
0; for larger nodule, cumulative artery ratio = 1.10, hepatic artery ratio =
0.80, portal vein ratio = 1.17. CT scan obtained during arterioportography
shows smaller lesion (arrow) has portal perfusion defect and larger
lesion appears isoattenuating. Smaller and larger nodules are classified as
groups 5 and 2, respectively.
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Fig. 2C. —69-year-old man with high-grade dysplastic nodule and
moderately differentiated hepatocellular carcinoma in right hepatic lobe.
Lesion-to-liver vascular ratios were as follows: for smaller nodule,
cumulative artery ratio = 1.42, hepatic artery ratio = 0, portal vein ratio =
0; for larger nodule, cumulative artery ratio = 1.10, hepatic artery ratio =
0.80, portal vein ratio = 1.17. Photomicrograph of histologic specimen of
larger nodule shows portal tracts accompany normal preexisting vascular
architecture. A = preexisting hepatic artery, P = portal vein, B = bile duct.
(H and E, x 136)
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Fig. 2D. —69-year-old man with high-grade dysplastic nodule and
moderately differentiated hepatocellular carcinoma in right hepatic lobe.
Lesion-to-liver vascular ratios were as follows: for smaller nodule,
cumulative artery ratio = 1.42, hepatic artery ratio = 0, portal vein ratio =
0; for larger nodule, cumulative artery ratio = 1.10, hepatic artery ratio =
0.80, portal vein ratio = 1.17. Photomicrograph of histologic specimen of
larger nodule also shows portal tract without preexisting hepatic artery. P =
portal vein, B = bile duct. (H and E, x140)
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Fig. 3A. —67-year-old woman with moderately differentiated
hepatocellular carcinoma within well-differentiated hepatocellular carcinoma
in right hepatic lobe. Lesion-to-liver vascular ratios are as follows: for
outer ring, cumulative artery ratio = 1.21, hepatic artery ratio = 0.69,
portal vein ratio = 0.79; for inner nodule, cumulative artery ratio = 1.63,
hepatic artery ratio = 0, portal vein ratio = 0. CT hepatic arteriogram shows
concentric ring with inner nodule. Outer ring is hypoattenuating and inner
nodule is hyperattenuating (arrows).
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Fig. 3B. —67-year-old woman with moderately differentiated
hepatocellular carcinoma within well-differentiated hepatocellular carcinoma
in right hepatic lobe. Lesion-to-liver vascular ratios are as follows: for
outer ring, cumulative artery ratio = 1.21, hepatic artery ratio = 0.69,
portal vein ratio = 0.79; for inner nodule, cumulative artery ratio = 1.63,
hepatic artery ratio = 0, portal vein ratio = 0. CT scan obtained during
arterioportography shows outer ring is isoattenuating and inner nodule is
hypoattenuating. On basis of enhancement patterns of CT hepatic arteriography
and CT during arterioportography, outer ring and inner nodule are classified
as groups 2 and 5, respectively.
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Fig. 3C. —67-year-old woman with moderately differentiated
hepatocellular carcinoma within well-differentiated hepatocellular carcinoma
in right hepatic lobe. Lesion-to-liver vascular ratios are as follows: for
outer ring, cumulative artery ratio = 1.21, hepatic artery ratio = 0.69,
portal vein ratio = 0.79; for inner nodule, cumulative artery ratio = 1.63,
hepatic artery ratio = 0, portal vein ratio = 0. Photomicrograph of histologic
specimen of portal tracts in outer ring shows abnormal vessels with severe
luminal narrowing or thickened walls (arrow). P = portal vein. (H and
E, x106)
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Fig. 4. —Chart shows correlation of lesion-to-liver vascular ratios
with lesion classification according to intranodular arterial and portal blood
supply in 86 lesions. Table 3
presents findings used to determine lesion classifications.
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Fig. 5. —Chart shows the relationship between pathologic gradings and
lesion-to-liver ratios in 86 lesions. LGDN = low-grade dysplastic nodule, HGDN
= high-grade dysplastic nodule, wHCC = well-differentiated hepatocellular
carcinoma, mHCC = moderately differentiated hepatocellular carcinoma, pHCC =
poorly differentiated hepatocellular carcinoma.
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Fig. 6. —Line graph shows relationship between development of
intranodular neovascularized arterial flow and deterioration of preexisting
hepatic arterial flow. Cumulative intranodular arterial flow is total of
preexisting hepatic arterial flow and neovascularized arterial flow. A =
initial point of decreasing intranodular arterial blood flow.
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Fig. 7A. —Relationship between intranodular blood flow and angiographic
CT appearance in CT hepatic arteriography and CT during arterioportography.
Hypo = hypoattenuation, iso = isoattenuation, hyper = hyperattenuation, A =
initial point of decreased intranodular arterial blood flow, P = initial point
of decreased intranodular portal blood flow. Line graph shows initial decrease
and subsequent increase in cumulative intranodular arterial blood flow
precedes decrease in intranodular portal blood flow.
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Fig. 7B. —Relationship between intranodular blood flow and angiographic
CT appearance in CT hepatic arteriography and CT during arterioportography.
Hypo = hypoattenuation, iso = isoattenuation, hyper = hyperattenuation, A =
initial point of decreased intranodular arterial blood flow, P = initial point
of decreased intranodular portal blood flow. Line graph shows deterioration of
intranodular cumulative arterial blood flow precedes decrease in intranodular
portal blood flow.
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Fig. 7C. —Relationship between intranodular blood flow and angiographic
CT appearance in CT hepatic arteriography and CT during arterioportography.
Hypo = hypoattenuation, iso = isoattenuation, hyper = hyperattenuation, A =
initial point of decreased intranodular arterial blood flow, P = initial point
of decreased intranodular portal blood flow. Line graph shows intranodular
portal and cumulative arterial blood flow decrease simultaneously.
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Fig. 7D. —Relationship between intranodular blood flow and angiographic
CT appearance in CT hepatic arteriography and CT during arterioportography.
Hypo = hypoattenuation, iso = isoattenuation, hyper = hyperattenuation, A =
initial point of decreased intranodular arterial blood flow, P = initial point
of decreased intranodular portal blood flow. Line graph shows deterioration of
intranodular portal blood flow precedes decrease in intranodular cumulative
arterial blood flow.
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Copyright © 2002 by the American Roentgen Ray Society.
