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Arterial Blood Supply of Hepatocellular Carcinoma and Histologic Grading: Radiologic-Pathologic Correlation

¹ Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
² Present address: Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242.
³ Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
⁴ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —65-year-old man with moderately differentiated hepatocellular carcinoma (group 1) in right lobe of liver. CT hepatic arteriography image obtained 15 seconds after contrast material injection shows hypoattenuating mass (arrow) compared with noncancerous region.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —65-year-old man with moderately differentiated hepatocellular carcinoma (group 1) in right lobe of liver. CT during arterioportography image shows isoattenuating mass compared with noncancerous region. Number of unpaired arteries is one, and Ki-67 labeling index is 9.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —72-year-old man with moderately differentiated hepatocellular carcinoma (group 2) in right lobe of liver. CT hepatic arteriography image obtained 15 seconds after contrast material injection shows very hyperattenuating mass (arrow) compared with noncancerous region.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —72-year-old man with moderately differentiated hepatocellular carcinoma (group 2) in right lobe of liver. CT during arterioportography image shows perfusion defect compared with noncancerous region. Number of unpaired arteries is 13, and Ki-67 labeling index is 25.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —52-year-old man with poorly differentiated hepatocellular carcinoma (group 3) in right lobe of liver. CT hepatic arteriography image obtained 15 seconds after contrast material injection shows hazy hyperattenuating mass (arrows) compared with noncancerous region.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —52-year-old man with poorly differentiated hepatocellular carcinoma (group 3) in right lobe of liver. CT during arterioportography image shows perfusion defect compared with noncancerous region. Number of unpaired arteries is nine, and Ki-67 labeling index is 80.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —50-year-old man with poorly differentiated hepatocellular carcinoma (group 4) in right lobe of liver. CT hepatic arteriography image obtained 15 seconds after contrast material injection from right hepatic artery shows hypoattenuating mass (arrows) compared with noncancerous region (arrowheads).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —50-year-old man with poorly differentiated hepatocellular carcinoma (group 4) in right lobe of liver. CT during arterioportography image shows perfusion defect (arrowheads) compared with noncancerous region. Number of unpaired arteries is three, and Ki-67 labeling index is 178.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —50-year-old man with poorly differentiated hepatocellular carcinoma (group 4) in right lobe of liver. Immunohistochemical staining of Ki-67. Nuclei of tumor cells were diffusely positive for Ki-67 staining.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Relationship between CT during arterioportography and CT hepatic arteriography findings and Ki-67 labeling index. Note that Ki-67 labeling index of group 4 was significantly higher than those of other groups.

View larger version (29K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Diagram shows changes of intratumoral arterial blood supply. In well-differentiated hepatocellular carcinoma (HCC) and moderately differentiated HCC, arterial blood supply increases as histologic grade progresses. Consequently, arterial blood supply decreases in poorly differentiated HCC as tumor grade advances. HCCs belonging to group 3 and group 4 and showing intermediate Ki-67 labeling index (here, it was defined as < 10)—that is, those considered to be on left side of peak (group 3' and group 4')—mainly consisted of moderately differentiated HCCs. HCCs belonging to group 3 and group 4 and showing high Ki-67 labeling index ( 10)—that is, those considered to be on right side of peak (group 3 and group 4)—mainly consisted of poorly differentiated HCCs. (Strictly speaking, it seems to be incompatible to place poorly differentiated HCC showing group 3' or group 4' into a portion labeled as well-differentiated HCC or moderately differentiated HCC. However, such tumor is rare.) Moderately differentiated HCC on line c shows same degree of arterial blood flow as poorly differentiated HCC on line d, but proliferative activity of HCC on line d is higher than that of HCC on line c. (It is difficult to distinguish d from c solely by means of CT hepatic arteriography and CT during arterioportography.) Poorly differentiated HCC on line e shows hypovascular and very high proliferative activity. It is possible to point out poorly differentiated HCC on line e, and thus we can predict proliferative activity of this type of tumor.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —Relationship between CT during arterioportography and CT hepatic arteriography findings and Ki-67. In this figure, group 3 was divided into group 3 and group 3', and group 4 was divided into group 4 and group 4'. Correlation between Ki-67 labeling index and hemodynamic sequence order of group 1, 4', 3', 2, 3, and 4 (rho = 0.872) was stronger than that between Ki-67 labeling index and sequence order of group 1, 2, 3, and 4 (rho = 0.677).

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