Evaluation Of Hepatocellular Carcinoma Research Articles

C-arm computed tomography parenchymal blood volume measurement in evaluation of hepatocellular carcinoma before transarterial chemoembolization with drug eluting beads.

BackgroundC-arm computed tomography (CT) guided intervention is an increasingly applied technique in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). The aim of this study was to analyse the value of parenchymal blood volume (PBV) maps acquired during C-arm CT acquisition, for pre-treatment evaluation and planning of TACE in HCC patients.MethodsA total of 64 HCC lesions in 29 patients (median age, 73 years, range, 62–77 years) were included in this retrospective study. All patients received cross-sectional imaging (MRI or CT) prior to TACE and C-arm CT PBV measurement acquisition before performing TACE. Results of cross-sectional imaging regarding the number of HCC lesions and maximum diameter were compared to PBV–maps. Number of lesions and tumour feeding vessels detected in PBV-maps were compared to conventional angiography. Results of PBV were analysed concerning different tumour morphologies (pre-treated, encapsulated and diffuse).ResultsPre-interventional cross-sectional imaging and PBV maps showed an excellent agreement in lesion diameter (p = 0.88, MD = −0.28 mm) and number of detected lesions (κ = 1.0). Compared to conventional angiography, PBV maps showed an increased number of detected lesions (κ = 0.77, p = 0.001) and tumour feeding vessels (κ = 0.71, p < 0.0001). Diffuse HCC lesion revealed a significantly lower PBV compared to encapsulated lesions (p = 0.0001).ConclusionsC-arm CT acquired PBV measurements detect HCC tumours with a lesion detectability comparable to pre-interventional cross-sectional imaging. Furthermore, this technique facilitates TACE, allowing a more precise localization of HCC lesions and tumour feeding vessels compared to conventional angiography. Additionally, calculated PBV values enable a real time quantitative assessment of tumour perfusion.

Comprehensive characterization and evaluation of hepatocellular carcinoma by LC–MS based serum metabolomics

The liver is an active organ in energy metabolism, and hepatocellular carcinomas (HCC) therefore unavoidably induce a series of metabolic alterations in the serum metabolome. In this study, 587 sera from HCC patients, hepatitis B virus (HBV) infected subjects and healthy control subjects were employed to characterize metabolic alterations using a liquid chromatography tandem mass spectrometry-based metabolomics approach. d-Galactose significantly increased whereas undecanoyl-l-carnitine and PE (P-18:0/0:0) decreased in HCC patients when compared with non-HCC controls (HBVs and NCs). These metabolites were finally identified as independent diagnostic factors for HCC discrimination. The combination of discriminative metabolites and alpha-fetoprotein could also significantly improve the diagnostic performance for HCC in terms of the sensitivity, specificity and area under the curve of the receiver operating characteristic curve; these three parameters displayed values of 0.96, 0.92 and 0.98, respectively. Furthermore, network and pathway analyses were conducted to explore the latent relationship among differential metabolites. In the network analysis, metabolites of diverse categories (including amino acids, dipeptides, phospholipids, fatty acids, steroids and acylcarnitines) reflected the correlation between metabolite categories on material and energy conversion in HCC. Meanwhile, metabolites mapped in the pathways for primary bile acid biosynthesis and alanine, aspartate and glutamate metabolism revealed a centrality and significant variances. These results indicated that substantial biochemical perturbations occurred in these pathways in HCC patients. In summary, our study revealed the systematic landscape for metabolic alterations in the serum of HCC patients and provides useful information to clinicians and biologists.

Comparison of diffusion-weighted imaging and gadoxetic acid-enhanced MR images in the evaluation of hepatocellular carcinoma and hypovascular hepatocellular nodules

PurposeTo compare diffusion-weighted imaging (DWI) and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI) in the evaluation of hepatocellular carcinoma (HCC) and nodules at high risk of HCC transformation. Materials and methodsWe evaluated nodules’ size, vascular pattern, and signal intensity on hepatobiliary phase images and on DWI of 105 nodules (41 cirrhotic patients). ResultsA total of 35/66 HCCs identified on Gd-EOB-DTPA MRI showed hyperintensity on DWI. A total of 25/39 nodules (hypovascular and hypointense nodule on hepatobiliary phase images) progressed to HCC (higher risk for nodules ≥10mm in size and hyperintense on DWI, P<.05). ConclusionGd-EOB-DTPA MRI demonstrated a significant role in the identification of nodule at higher risk of HCC transformation, and hyperintensity on DWI was associated with progression to HCC.

Value of gadoxetic acid-enhanced and diffusion-weighted MR imaging in evaluation of hepatocellular carcinomas with atypical enhancement pattern on contrast-enhanced multiphasic MDCT in patients with chronic liver disease

ObjectiveThe purpose of this study was to investigate the value of enhancement kinetics and ancillary imaging findings on gadoxetic acid-enhanced and diffusion-weighted (DW) MR imaging for diagnosing hepatocellular carcinomas (HCCs) without the typical enhancement pattern on contrast-enhanced multiphasic MDCT in patients with chronic liver disease. Materials and methodsEighty-two surgically confirmed HCCs without the typical enhancement pattern (hypervascular in the arterial phase, followed by washout on the portal or equilibrium phases) on triple-phase MDCT were enrolled in this study. The patients were classified into four categories based on the CT density pattern of arterial and equilibrium phases (isodense–isodense, hypodense–hypodense, isodense–hypodense, and hyperdense–isodense) compared to liver parenchyma. Signal intensity of HCCs on T2-weighted images (T2WI), arterial phase, 3min late-phase, hepatobiliary phase (HBP) and DW images with a b value of 800s/mm2 were qualitatively evaluated, and ADC values were measured. Fisher's exact test and Chi-square test were used to compare the frequency and trend of hyperintensity on T2WI, hypointensity on HBP images, hyperintensity on DW images, and histopathologic grades between groups with different CT density patterns. Kruskal–Wallis test was used to compare the ADC value between groups. ResultsThirty and 52 HCCs were categorized as hypervascular (hyperdense–isodense) and non-hypervascular HCCs (3, isodense–isodense; 37, hypodense–hypodense; 12, isodense–hypodense), respectively. Most HCCs showed hyperintensity on T2WI (77/82, 93.9%) and DW images (81/82, 98.8%) and hypointensity on HBP images (80/82, 97.6%). Thirty-eight HCCs (38/82, 46.3%) showed typical HCC enhancement pattern on dynamic MR images. There were no significant differences in the frequency and trend of signal intensity on T2WI, HBP images, DW images, and histopathologic grades with regard to the four CT density patterns (p<0.05). No significant difference in mean ADC values between groups was identified (p<0.05). ConclusionGadoxetic acid-enhanced and DW MR imaging can help diagnose HCCs with atypical enhancement patterns on multiphasic CT in patients with chronic liver disease.

Situs inversus totalis with congenitally corrected transposition of the great arteries: insights from cardiac MRI.

IntroductionSitus inversus totalis with congenitally corrected transposition of the great arteries represents a relatively rare congenital condition.Case descriptionThe current report describes the case of a 56 year old patient with an atrio-ventricular and ventricular-arterial discordance of the heart chambers without surgical correction, incidentally detected during hepatocellular carcinoma evaluation. The systemic venous blood arrived via the right atrium and a mitral valve in the morphologically left but pulmonary arterial ventricle that gave rise to a pulmonary trunk. The pulmonary venous blood passed the left atrium and the tricuspid valve into a morphologically right but systemic ventricle that gave rise to the aorta.Discussion and evaluationThe switched anatomy was incidentally detected on echocardiography. The patient was referred to cardiac magnetic resonance imaging (CMR) including flow measurements, volumetry and late enhancement. CMR results showed a mildly impaired function and the switched anatomy. During a follow-up period of 2 years the patient was suffering from only mild heart failure and dyspnea.ConclusionsHeart failure symptoms and arrhythmias can appear with increasing age in patients with congenitally corrected transposition. Early CMR allows accurate diagnosis and timely introduction of adequate therapy thereby avoiding disease progression.

Computer-Assisted Evaluation of Contrast Kinetics for Detection of Hepatocellular Carcinoma on Magnetic Resonance Imaging

The purpose of this study was to assess the use of semiquantitative contrast-enhanced parameter analysis as an objective criteria for improving the magnetic resonance (MR) evaluation of hepatocellular carcinoma (HCC) in patients with cirrhosis. Contrast-enhanced MR examination findings from 19 patients with 21 pathologically proven HCC were evaluated using a dedicated liver image postprocessing workstation. Contrast-enhancement kinetic curves were created for each lesion, and 4 enhancement parameters (arterial wash-in slope, arterial-portal slope, arterial-equilibrium slope, and portal-equilibrium slope) were defined from the signal intensity-time plots. The accuracy of each enhancement parameter for the characterization of HCC was assessed. Statistical analysis revealed that an arterial-phase wash-in slope percentage value >1.35 per sec had a sensitivity of 86%, a specificity of 71%, and an accuracy of 79% for the correct characterization of HCC, whereas an arterial-equilibrium wash-out slope percentage value<0.05 per sec had a sensitivity of 86%, a specificity of 81%, and an accuracy of 83%. Although there were significant differences among all groups, the greatest accuracy for differentiation based on receiver operating curve analysis appears to be with arterial and arterial-equilibrium phases. Semiquantitative analysis of lesion contrast kinetics could provide objective parameters to improve the characterization of HCC on contrast-enhanced MR images.

Comparison of volume perfusion computed tomography (VPCT) and contrast-enhanced ultrasound (CEUS) for assessment of therapeutic effect of transarterial chemoembolisation (TACE)

Zielsetzung: To compare contrast-enhanced ultrasound (CEUS) and volume perfusion computed tomography (VPCT) for response evaluation of hepatocellular carcinoma (HCC) to transarterial chemoembolisation (TACE). Material und Methodik: Twenty consecutive patients with inoperable HCC underwent CEUS and VPCT in the pre- and post-TACE setting (mean, 1 day). Quality of CEUS and VPCT was rated as good/adequate/poor. Good and adequate were rated as diagnostic. We measured hepatic perfusion index (HPI), arterial liver perfusion (ALP), blood flow (BF) and blood volume (BV) at both time points by VPCT, calculated ratios and their sensitivity/specificity/negative (NPV) and positive predictive values (PPV) as well as cut-off values for these parameters as thresholds between responders and non-responders. VPCT and CEUS images were rated also according to mRECIST. Tumor response defined by mRECIST at follow-up (mean, 56 days) was accepted for validation. Ergebnisse: CEUS and VPCT yielded correct diagnosis in 20/20 cases. 10/20 patients showed at follow-up a complete response. There was a significant reduction of viable tumor tissue in all patients according to mRECIST (p 29,6% (all 100%), in BV of > 41,4% (all 100%), or in BF of > 53,1% (90%/100%/90%/100%) was indicative of response. Schlussfolgerungen: CEUS performs equally to VPCT for assessment of response to TACE in HCC. E-Mail: kaufmann.79@web.de

Evaluation of hepatocellular carcinoma with computed tomography perfusion imaging

To evaluate the role of computed tomography (CT) perfusion imaging in patients with hepatocellular carcinoma (HCC). Seventeen patients (9 men, 8 women) with newly diagnosed HCC, proven by biopsy, were evaluated with 256-slice helical CT. Perfusion parameters of blood flow (BF), blood volume (BV), arterial perfusion (AP), portal perfusion (PP), and hepatic perfusion index (HPI) were calculated in the normal liver parenchyma and HCC samples. A total of 21 histologically proven HCC lesions were evaluated from CT perfusion images. BF, BV, AP, and HPI values were shown to be significantly higher (P < 0.05) in the HCC lesions than in the normal liver parenchyma. Conversely, PP values were found to be significantly lower (P < 0.05) in HCC relative to liver parenchyma. CT perfusion imaging has the ability to evaluate tumor assessment, characterization, and neoangiogenesis in HCC.

Contrast ultrasound in hepatocellular carcinoma at a tertiary liver center: First Indian experience

To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemo-embolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2 (4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2 (4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc. CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions. CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.

Application of hepatic tumor-specific magnetic resonance enhancement with Gd-EOB-DTPA in the preoperative evaluation of hepatocellular carcinoma

Hepatic tumor-specific magnetic resonance (MR) enhancement with Gd-EOB-DTPA can detect and distinguish small hepatocellular carcinoma (HCC) with greater sensitivity than conventional magnetic resonance imaging and computed tomography.Hepatic tumor-specific MR enhancement with Gd-EOB-DTPA is more sensitive in detecting focal HCC,and more reliable in detecting lesions with a diameter smaller than 2cm.Gd-EOB-DTPA is excreted through the kidneys and biliary tract,and thus may provide more information about anatomic structures,demonstrate non-obstruction of the intra- and extrahepatic bile duct system,and provide information about hepatic function. Key words: Liver neoplasms ; Gd-EOB-DTPA ; Magnetic resonance ;

Clinical significance of circulating sICAM-1 and GPC-3 mRNA expression in the diagnosis and prognostic evaluation of hepatocellular carcinoma

Clinical significance of circulating sICAM-1 and GPC-3 mRNA expression in the diagnosis and prognostic evaluation of hepatocellular carcinoma

Application of dual-source CT in the evaluation of hepatocellular carcinoma after transarterial chemoembolization treatment

Objective To assess the diagnostic value of dual-energy dual-source CT in detecting the enhancement of hepatocellular cancer ( HCC ) after transarterial chemoembolization ( TACE )treatment.Methods Twenty-seven patients with HCC underwent dual-energy dual-source CT including nonenhanced,arterial,portal,and delayed phases scanning after TACE treatment.Arterial phases were acquired with the dual-energy mode for reconstruction of virtual nonenhanced images and color overlay images.DSAs were performed in all these patients.Two blinded and independent readers evaluated the data in 2 reading sessions:standard nonenhanced,arterial phase,portal phase,and delayed phase images were read in session A,and virtual nonenhanced,arterial phase,portal phase,and delayed phase images in session B.Sensitivity and specificity were calculated,with the DSA data set as the reference standard.The sensitivity and specificity were compared with Chi-square test.Results DSA revealed 63 lesions in 27 patients,and 39 of them had blood supply.Overall sensitivity and specificity were 74.4％ (29/39) and 83.3％ (20/24) for session A,and 94.9％ (37/39),95.8％ (23/24) for session B,respectively.The sensitivity of the two reading sessions was significantly different (x2 =6.303,P ＜ 0.05 ),while the specificity was insignificantly different ( x2 =2.009,P ＞ 0.05 ).Conclusion Compared with standard dynamic protocols,an arterial dual-energy dual-source CT scan with reconstruction of virtual nonenhanced and color overlay images enables detection of relapse and intrahepatic metastasis of HCC after TACE treatment with higher accuracy. Key words: Carcinoma, hepatocellular; Radiology, interventional; Tomography, X-ray computed

Evaluation of Hepatocellular Carcinoma by Contrast-Enhanced Sonography

The purpose of this study was to determine whether contrast-enhanced sonography can be used to differentiate histopathologic grades of hepatocellular carcinoma. This study included 54 patients with hepatocellular carcinomas. All patients underwent fundamental and contrast-enhanced sonographic examinations. Auto-tracking contrast quantification software was used to determine the contrast arrival time, time to peak, peak intensity, contrast-enhanced time, wash-out time, enhancement slope, and clearance slope of the lesions. All lesions were confirmed by surgery. The hepatocellular carcinoma lesions were divided into 2 groups according to the World Health Organization grading system: group 1 (well-differentiated hepatocellular carcinomas) and group 2 (moderately to poorly differentiated carcinomas). The enhancement parameters between the groups were compared using a Student t test. Fourteen of 20 well-differentiated lesions showed a "fast-in, slow-out" enhancement pattern, whereas 6 showed a "fast-in, fast-out" pattern. Thirty-three of 34 moderately to poorly differentiated lesions showed a fast-in, fast-out pattern, whereas only 1 showed a fast-in, slow-out pattern. The differences in the time to peak, contrast-enhanced time, wash-out time, enhancement slope, and clearance slope between the groups were statistically significant (P < .05), whereas the differences in the arrival time and peak intensity were not significant (P > .05). The contrast patterns of well-differentiated and moderately to poorly differentiated hepatocellular carcinomas were quite different on contrast-enhanced sonography. The time to peak, contrast-enhanced time, and wash-out time of the well-differentiated hepatocellular carcinomas were longer than those of the moderately to poorly differentiated carcinomas, whereas the enhancement slope and clearance slope of the well-differentiated lesions were lower those that of the moderately to poorly differentiated lesions.

MR-arterioportography: A new technical approach for detection of liver lesions

To evaluate the benefit and effectiveness of MR-arterioportography (MR-AP) to achieve the highest sensitivity for detection and evaluation of hepatocellular carcinoma (HCC). Twenty liver cirrhosis patients with suspected HCC were included before transarterial chemoembolization. In all patients double-enhanced Magnetic resonance imaging (MRI) was performed. A bolus of 10 mL Magnevist® was injected through a selectively placed catheter in the superior mesenteric artery and MRI of the liver was performed in arterioportographic phase. Two independent readers evaluated number, size and localization of detected lesions. Diagnostic quality was determined using a 4-point scale. Differences were analyzed for significance using a t-test. Interobserver variability was calculated. In all 20 patients (100%), MR-AP was feasible. Diagnostic quality was, in all cases, between 1 and 2 for both modalities and readers. MR-AP detected significantly more lesions than double-enhanced MRI (102.5 vs. 61, respectively, P < 0.0024). The inter-observer variability was 0.881 for MRI and 0.903 for MR-AP. Our study confirmed that the MR-AP as an additional modality for detection of HCC is beneficial, as significantly more lesions were detected compared to MRI with liver-specific contrast.

Added Value of Gadoxetic Acid–enhanced Hepatobiliary Phase MR Imaging in the Diagnosis of Hepatocellular Carcinoma

To determine the added value of hepatobiliary phase images in gadoxetic acid-enhanced magnetic resonance (MR) imaging in the evaluation of hepatocellular carcinoma (HCC). Institutional review board approved this retrospective study and waived the informed consent. Fifty-nine patients with 84 HCCs underwent gadoxetic acid-enhanced MR examinations that included 20-minute delayed hepatobiliary phase imaging. MR imaging was performed with a 1.5-T system in 19 patients and a 3.0-T system in 40 patients. A total of 113 hepatic nodules were documented for analysis. Three radiologists independently reviewed two sets of MR images: set 1, unenhanced (T1- and T2-weighted) and gadoxetic acid-enhanced dynamic images; set 2, hepatobiliary phase images and unenhanced and gadoxetic acid-enhanced dynamic images. For each observer, the diagnostic accuracy was compared by using the area under the alternative free-response receiver operating characteristic curve (A(z)). Sensitivity and specificity were also calculated and compared between the two sets. For all observers, A(z) values were higher with the addition of the hepatobiliary phase. The observer who had the least experience in abdominal imaging (2 years) demonstrated significant improvement in A(z), from 0.895 in set 1 to 0.951 in set 2 (P = .049). Sensitivity increased with the addition of hepatobiliary phase images but did not reach statistical significance. Nine HCCs (10.7%) in six patients (10.1%) were seen only on hepatobiliary phase images. Hepatobiliary phase images obtained after gadoxetic acid-enhanced dynamic MR imaging may improve diagnosis of HCC and assist in surgical planning.

Evaluation of hepatocellular carcinoma with portal vein tumor thrombosis by CEUS before and after hepatic arterial infusion chemotherapy.

Hepatocellular carcinoma (HCC) is one of the most common neoplasms worldwide. Portal vein tumor thrombosis (PVTT) is a common complication of advanced HCC, and the prognosis of advanced HCC with PVTT is extremely poor. We report a case of HCC with PVTT evaluated by contrast-enhanced ultrasonography (CEUS) before and after hepatic arterial infusion chemotherapy (HAIC). A 59-year-old man with chronic hepatitisC was admitted to our hospital. CEUS clearly showed the thread and streaks sign in a solid lesion that occupied the right main branch of the portal vein. HAIC was performed, and CEUS after HAIC clearly showed disappearance of the thread and streaks sign. CEUS was very useful in diagnosing PVTT and in evaluating the effectiveness of HAIC in this case.

The clinical applicationof multi-slice spiral CT angiography in evaluation of hepatocellular carcinoma

：Objective To compare thevalue of biphasicmulti-detector row helical computed tomogrpahy(MDCT),digital subtractionangiography(DSA)and lipiodol computed tomography(CT)in hypervascular hepatocellularcarcinoma(HCC).Methods 80 cases with liver cancer were underwent MDCT、DSA、iodizedoil CT scan,then compared detection rates of three methods.Results In detecting hepaticnodules(＞2cm),these three imaging techniques had the same sensitivity;for 1～2cmhepatic nodules,the detecting rate had no significant difference;The MDCT scan＜1cmdetected 47 nodules(94.0%),iodized oil CT detected 27 nodules(54.0%),both statisticallysignificant difference in detection rate(χ~2=3.11,P＜0.01),DSAis only detected 16 nodules(32.0%)compared with enhanced dual-phase MDCT scan and iodizedoil CT detection rate the differences were statistically significant(χ~2=9.09,9.03,allP＜0.01).ConclusionMDCT is able to better show feeding arteries of hepatocellular carcinoma,The imagingexamination of liver cancer before treatment can be used as a comprehensive evaluation. Key words: Liver neoplasms; Tomography,X-ray computed; Digitalsubtraction angiography; Iodized oil

Clinical application of volume rendering of portal-vena cava area by 16-slice spiral CT for diagnosis and evaluation of hepatocellular carcinoma

原发性肝癌(primary hepatocellular carcinoma,HCC)容易发生门腔区(porta caval region,PCR)转移,其病理改变为肝胆外科术前重点关注的内容之一.笔者探讨16层螺旋CT门腔区容积成像(volume rendering,VR)在原发性肝癌诊断中的应用及评价。

Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification for the early evaluation of hepato cellular carcinoma treated by bevacizumab in phase II

4588 Background: To determine the best quantitative parameters of DCE-US at D3 and 7 for predicting the response at 3 months to bevacizumab in patients with hepato cellular carcinoma (HCC). Methods...

Role of Early Arterial Phase Multislice Helical CT Angiography in Evaluation of Hepatocellular Carcinoma

Objective: To investigate the clinical application of early arterial phase multislice CT angiography (MSCTA) of hepatic vessels in evaluation of middle or advanced stage hepatocellular carcinoma. Methods: Trigger Bolus program was used to carry out MSCTA in early and late arterial phases and portal vein phase with single breath holding. Hepatic vessels were reconstructed from the original images of early arterial phase by post processing. The blood supply of tumor and normal liver tissue and the appearances of venous thrombosis and arteriovenous shunts were analyzed. Results: The MSCTA with early arterial phase could perfectly display the origin, shape and amount of feeding vessels to normal liver tissue and tumor in middle or advanced stage hepatocellular carcinoma. It had the ability of displaying the arteriovenous shunts better than that in conventional dual phased liver scanning. Conclusion: MSCTA of hepatic vessels with early arterial phase acquisition using multislice helical CT in middle or advance stage hepatocellular carcinoma has favorable and promising application. It can be used as an imaging method for comprehensive assessment of the hepatocellular carcinoma before treatment.