Abstract
Tumor hemodynamics of carcinogenic hepatocytes nodules, that is, low grade dysplastic nodules, high grade dysplastic nodules, early hepatocellular carcinomas (HCCs), and progressed HCCs, change during multistep dedifferentiation of the nodules. Morphometric analyses of inflow vessels of these nodules indicate that the portal veins of carcinogenic hepatocyte nodules monotonically decrease whereas the arteries bitonically change, first decrease and then increase. Findings on imaging techniques depicting these changes in tumor blood inflows, especially intra-arterial contrast-enhanced computed tomography, closely related not only to the histological differentiation of the nodules but also to the outcomes of the nodules. Histological analyses of connections between the vessels within the tumors and those in the surrounding livers and findings on imaging techniques indicate that drainage vessels of HCC change from hepatic veins to hepatic sinusoids and then to portal veins during multistep hepatocarcinogenesis. Understanding of tumor hemodynamics through radio-pathological correlations will be helpful in drawing up therapeutic strategies for carcinogenic hepatocyte nodules arising in cirrhosis.
Highlights
A stepwise model of development, from well-differentiated precursors to poorly differentiated progressed hepatocellular carcinomas (HCCs), is well established by evidences accumulated in the past three decades
This review focuses on radiologic hemodynamic features of carcinogenic hepatocyte nodules arising from cirrhotic livers, that is, dysplastic nodules, early HCCs, and progressed HCCs, paying close attention to radio-pathological correlations and outcomes of the nodules
Hemodynamics of carcinogenic hepatocyte nodules depicted with imaging techniques, especially with CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA), are closely related to differentiations, growth patterns, and outcomes of the nodules
Summary
A stepwise model of development, from well-differentiated precursors to poorly differentiated progressed hepatocellular carcinomas (HCCs), is well established by evidences accumulated in the past three decades. The criteria involve pathologic and radiologic features, especially hemodynamic findings. Progressed HCCs are defined as radiologically hypervascular lesions without portovenous supply which histologically appear moderately or poorly differentiated; early HCCs and dysplastic nodules are defined as iso- or hypovascular lesions with portovenous supply on radiological images which appear well differentiated on histology [1, 2]. This review focuses on radiologic hemodynamic features of carcinogenic hepatocyte nodules arising from cirrhotic livers, that is, dysplastic nodules, early HCCs, and progressed HCCs, paying close attention to radio-pathological correlations and outcomes of the nodules
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