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Transcatheter arterial chemoembolization (TACE) is widely performed in 32% of the patients with unresectable hepatocellular carcinoma (HCC) at initial diagnosis and in 58% of those with recurrent HCC in Japan. However, the patient population which undergoes TACE is heterogeneous, and thus the 3-year survival rate varies from 26 to 47%. The selection criteria for TACE is 2-3 tumors3 cm or 4 or more tumors in patients with liver damage A/B (corresponding well to Child-Pugh class A/B) and absence of vascular invasion and extrahepatic spread, as proposed by Japanese guidelines. The 3-year survival rate of TACE for patients with 2-3 tumors3 cm or 4 or more tumors was 55 and 46%, respectively, in Child-Pugh A and 30 and 22%, respectively, in class B. These outcomes could help to understand the various results of TACE in different backgrounds in the East and West. Recently, TACE with calibrated drug-eluting beads loaded with doxorubicin showed a similar tumor response and radioembolization with yttrium-90 microspheres demonstrated a similar median survival compared with conventional TACE. Based on these results, the combination of TACE and novel molecular targeted agents can be used to elucidate the synergic effect on survival.

Early hepatocellular carcinoma (HCC) has been defined as a well-differentiated cancer containing Glisson's triad, but it remains unknown whether this lesion is curable. We prospectively studied 70 patients (enrolled from 1,172 referrals between 1982 and 1991) who had a diagnosis of a single HCC 2 cm or less in diameter (Stage T1) and who underwent curative hepatectomy and long-term follow-up (range, 0.2 to 14.3 years). Patients were eligible for surgery if they had a tumor that met the diagnostic criteria for HCC and were in Child-Pugh class A (n = 59) or B (n = 11) status. Among the 70 patients, there was 1 operative death. Based on our typing system, the tumors were assigned as early HCC (n = 15), overt HCC (n = 52), and non-HCC tumor (n = 3). The rate of microscopic regional spread was lower in early HCCs than in overt HCCs (7% vs. 42%; P = .01). The early HCC group had a longer time to recurrence than did the overt HCC group (3.9 vs. 1.7 years; P < .001) and had no local recurrence. After a median follow-up of 6.3 years, both overall survival and recurrence-free survival in the early HCC group were significantly better than those in the overt HCC group (P = .01; P = .001). In these two groups, the 5-year rates of overall survival were 93% and 54% (P = .01), and those of recurrence-free survival were 47% and 16% (P = .05), respectively; a significant survival benefit persisted over a decade (57% vs. 21%; P = .05). The early HCC group was at a lower risk of recurrence (relative risk, 0.31; 95% CI, 0.15 to 0.65; P = .002) and death (relative risk, 0.26; 95% CI, 0.09 to 0.73; P = .01) than was the overt HCC group. Early HCC is a distinct clinical entity with a high rate of surgical cure, thereby justifying its definition. It can be a lesion that corresponds to "Stage 0" cancer in other organs.

A 5-cm pheochromocytoma located in segment 7 of the liver was found incidentally in a 45-year-old man with mild diabetes mellitus and hypertension, and resected. The tumor was demonstrated by computed tomography and magnetic resonance imaging to have completely invaginated itself into the liver and to be receiving blood from a dilated right hepatic artery alone. Surgery revealed the hepatic mass to be tightly adherent to the right adrenal gland. The histopathologic diagnosis was pheochromocytoma growing exophytically from the right adrenal gland. There was no association with multiple endocrine neoplasia type 1 and type 2. A postoperative 131I metaiodobenzylguanidine scan revealed no accumulation, and the patient is currently doing well without recurrence or hypertension one year after the operation. A pheochromocytoma deeply invaginating into the liver should be considered in the differential diagnosis of primary hypervascular hepatic tumors.

For two patients with partial Budd‐Chiari syndrome secondary to hepatocellular carcinoma, dynamic CT was evaluated. The obstructed hepatic veins were both the middle and left hepatic veins in Case 1 and the right hepatic vein in Case 2. The area affected by obstructed hepatic vein(s) was seen as low density on both unenhanced and contrast enhanced CT in Case 1 and as high density on enhanced CT in Case 2. The border of attenuation differences caused by the obstruction of the middle (Case 1) or right (Case 2) hepatic vein was intersegmental planes of the anterior segment of the right lobe, and that caused by the obstruction of the left hepatic vein was the intersegmental plane of the medial third of the left lateral segment. Once intersegmental attenuation difference is recognized on CT, partial Budd‐Chiari syndrome should be considered.

A 64-year-old man who underwent hepatectomy for hepatocellular carcinoma (HCC) 4 years ago followed by transarterial chemoembolization for recurrent foci 1 year later had a thrombus in the inferior vena cava (IVC). Tumor thrombus derived from HCC was suspected owing to the increase in size and hepatic arteriography was performed. Common hepatic arteriography demonstrated a small stain suggesting a recurrent HCC in the remnant liver. However, CT during hepatic arteriography revealed that the stain localized not in the liver but within the thrombus in the IVC; there was no recurrent HCC in the liver. The dense stain associated with thin neovasculature developed through the thrombus was recognized. The thrombus spontaneously regressed 8 months later. It was speculated that the neovasculature played an important role in a process of absorption of the thrombus. One should note that the stain shown on angiography does not always suggest that the lesion is localized in the liver and is malignant.

Transcatheter arterial chemoembolization has been performed worldwide for patients with unresectable hepatocellular carcinoma for three decades. After long controversy, survival benefit was revealed by two randomized controlled trials. In Japan, chemoembolization accounted for initial treatment of 32% of patients and 58% for recurrent foci. The indications of chemoembolization are various: they are multinodular tumors in the Barcelona Clinic Liver Cancer staging system and two or three tumors >3 cm or four or more tumors in the Japanese guidelines, and both indications fulfill the Child-Pugh Class A/B or liver damage A/B and exclusion of vascular invasion or extrahepatic spread. Recently, both guidelines were identified to have almost similar content. The 4966 patients stratified to chemoembolization recommended by the Japanese guidelines showed that 3-year survival of patients with two or three tumors >3 cm or four or more tumors was 55 and 46% in Child-Pugh A, respectively, and 30 and 22% in Class B, respectively. These results would help in comparing the outcome of chemoembolization in the different backgrounds of the East and West. The modified Response Evaluation Criteria in Solid Tumor guideline is now proposed to cover the deficiency of Response Evaluation Criteria in Solid Tumor to evaluate the response to chemoembolization. Recently, chemoembolization with drug-eluting beads and radioembolization with yttrium-90 microspheres have been introduced, and each of them showed similar tumor response and median survival compared with conventional chemoembolization. Moreover, the combination of chemoembolization and molecular targeted agent is now on-going to evaluate the synergistic effect.

Background High recurrence rates after liver resection with curative intent for hepatocellular carcinoma (HCC) remain a problem. The characterization of long-term survivors without recurrence after liver resection may help improve the therapeutic strategy for HCC. Methods A nationwide Japanese database was used to analyse 20 811 patients with HCC who underwent liver resection with curative intent. Results The 10-year recurrence-free survival rate after liver resection for HCC with curative intent was 22·4 per cent. Some 281 patients were recurrence-free after more than 10 years. The HCCs measured less than 5 cm in 83·2 per cent, a single lesion was present in 91·7 per cent, and a simple nodular macroscopic appearance was found in 73·3 per cent of these patients; histologically, most HCCs showed no vascular invasion or intrahepatic metastases. Multivariable analysis revealed tumour differentiation as the strongest predictor of death from recurrent HCC within 5 years. Conclusion Long-term recurrence-free survival is possible after liver resection for HCC, particularly in patients with a single lesion measuring less than 5 cm with a simple nodular appearance and low tumour marker levels.

近年の腹部超音波検査, computed tomography, 経皮経肝門脈造影など診断技術, 機器の発達により肝内の脈管構築の把握がより容易になってきている. 今回われわれは画像診断で異常な肝内門脈走行を示したl Trlを経験した. 症例は肝腫場にて精査中門脈右前枝の裏状の拡張, 門脈左枝踏部の欠損, 肝円索の位置異常を認めた. このような肝内門脈の異常走行例はごくわずかで (0.1%) その原因は胎児期の発生異常と考えられた. 画像診断による肝内の脈管構築の把握は肝切除術特に脈管処理に際して重要である.

Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan, Department of Diagnostic Radiology, Seoul National University Hospital, The Korean Liver Cancer Study Group, Seoul, South Korea, Division of Gastroenterology and Hepatology, Taipei City Hospital, Taipei, Taiwan, Department of Surgery, Graduate School of Medicine, Kyoto University, The Liver Cancer Study Group of Japan, Kyoto, Japan, Social Insurance Alliance Shimonoseki Kohsei Hospital, Yamaguchi, Japan, Department of Internal Medicine and Radiology, Taipei City Hospital, Taipei, Taiwan, Department of Hepato-Gastroenterology, Yuan’s General Hospital, Kaohsiung, Taiwan and The Liver Cancer Study Group of Taiwan

Gastrointestinal hemorrhage from hepatocellular carcinoma invading the duodenum is very rare. A 60-year-old man with multiple hepatocellular carcinoma was admitted to our hospital because of massive melena and hematemesis. We succeeded in hemostasis of an esophageal variceal rupture by endoscopic varicial ligation. The duodenum could not be observed endoscopically due to extramural compression to the stomach from the liver tumor. Massive gastrointestinal hemorrhage occurred again and the patient died of hepatic failure. The postmortem examination revealed that the liver tumor had invaded the second portion of the duodenum and perforated into the lumen.

We report a 41-year-old woman with a retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe. Dynamic computed tomography in the early phase showed an enhanced tumor (2.7 cm in diameter) in the Spiegel lobe of the liver, which compressed the inferior vena cava (IVC). We also performed left hepatic angiographic computed tomography, and found that the tumor was less enhanced. The patient underwent laparotomy under a preoperative diagnosis of primary hepatic caudate tumor with faint neovascularity. At surgery, the tumor was found to be located between the left caudate lobe and the IVC, and was resected as being of a retroperitoneal origin. This case illustrates that tumor location must be determined with great care when the mass seems to exist at the dorsal edge of the liver, and especially when the tumor is hypovascular.

Background & Aims: To elucidate the survival of the patients with unresectable hepatocellular carcinoma (HCC) who underwent transcatheter arterial lipiodol chemoembolization (TACE) and to analyze the factors affecting the survivals. Methods: During the last 8 years, a nationwide prospective cohort study was performed in 8510 patients with unresectable HCC who underwent TACE using emulsion of lipiodol and anticancer agents followed by gelatin sponge particles as an initial treatment. Exclusion criteria were extrahepatic metastases and/or any previous treatment prior to the present TACE. The primary end point was survival. The survival rates were calculated by the Kaplan–Meier method. The multivariate analyses for the factors affecting survival were evaluated by the Cox proportional hazard model. The mean follow-up period was 1.77 years. Results: For overall survival rates by TACE, median and 1-, 3-, 5-, and 7-year survivals were 34 months, 82%, 47%, 26%, and 16%, respectively. Both the degree of liver damage and the tumor-node-metastasis (TNM) system proposed by the Liver Cancer Study Group of Japan demonstrated good stratification of survivals (P = .0001). The multivariate analyses showed significant difference in degree of liver damage (P = .0001), α-fetoprotein value (P = .0001), maximum tumor size (P = .0001), number of lesions (P = .0001), and portal vein invasion (P = .0001). The last 3 factors could be replaced by TNM stage. The TACE-related mortality rate after the initial therapy was .5%. Conclusions: TACE showed safe therapeutic modality with a 5-year survival of 26% for unresectable HCC patients. The degrees of liver damage, TNM stage, and α-fetoprotein values were independent risk factors for patient survival.

Early hepatocellular carcinoma (HCC) as defined by the Liver Cancer Study Group of Japan would correspond to high-grade dysplastic nodules with small foci of HCC in the majority of cases, using the classification system proposed by the International Working Party. A large number of early HCCs were revealed to be hypo- or isovascular in the arterial phase of dynamic CT. Only 5% of the lesions evaluated were hypervascular, which contrasted with advanced small HCCs, of which 94% were hypervascular. CT arterial portography (CTAP) showed hypoattenuation in 66% of early HCCs and isoattenuation in 34%. CT hepatic arteriography (CTHA) demonstrated hypoattenuation in 55% of early HCC, isoattenuation in 30% and hyperattenuation in 15%. These findings suggest that most early HCCs receive equal or reduced blood supply from both portal and arterial flow compared with surrounding noncancerous parenchyma. In contrast, 97% of small HCCs are hypoattenuated on CTAP, and 93% are hyperattenuated on CTHA. For nodule-in-nodule type HCC (advanced HCC within early HCC), the CT attenuation of the central and peripheral portions revealed areas of isolated advanced HCC and isolated early HCC, respectively. Adenomatous hyperplasia (low-grade dysplastic nodules) was not readily differentiated using the various imaging modalities, mainly due to the smaller size of these lesions compared to early HCC and/or a portal and arterial blood supply very similar to that of the surrounding parenchyma. Hemodynamic changes in cirrhotic liver were similarly evaluated using CTAP and CTHA, and the treatment of early HCC is briefly discussed herein.

BACKGROUND Advances in the diagnosis and surgical treatment of hepatocellular carcinoma (HCC) have improved the prognosis for patients with HCC who undergo liver resection. The objective of this study was to evaluate prognostic predictors for patients with HCC who underwent liver resection in a Japanese nationwide data base. METHODS In this study, the authors analyzed 12,118 patients with HCC in a Japanese nationwide data base who underwent liver resection between 1990 and 1999 and compared them with a previous analysis of patients between 1982 and 1989. All patients were evaluated for prognostic factors. RESULTS During the last decade, the increases in patients who were without hepatitis B virus surface antigen, who had small tumors, and who had portal vein invasion were noted. The 5-year overall survival rates for patients with HCC improved to 50.5%, compared with < 40% in the previous analysis. A multivariate analysis using a stratified Cox proportional hazards model according to associated liver disease indicated that age, degree of liver damage, α-fetoprotein level, maximal tumor dimension, number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic vein invasion, surgical curability, and free surgical margins were independent prognostic predictors for patients with HCC. Operative mortality decreased from 2.3% in 1990–1991 to 0.6% in 1998–1999. CONCLUSIONS Outcomes and operative mortality rates in patients with HCC improved during the last decade. Age, degree of liver damage, α-fetoprotein level, maximal tumor dimension, number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic vein invasion, surgical curability, and free surgical margins were prognostic factors for patients with HCC who underwent liver resection. Cancer 2004. © 2004 American Cancer Society.

We describe a case of rupture of a liver metastasis from esophageal leiomyosarcoma which was treated successfully by hepatic arterial embolization, thus facilitating hepatectomy. A 59-yearold woman who had previously undergone esophagectomy for leiomyosarcoma was admitted in a state of hypovolemic shock. Ultrasonography revealed multiple tumors in the left lobe of the liver and massive intraperitoneal hemorrhage, confirmed by paracentesis, possibly due to spontaneous rupture. Subsequent hepatic angiography showed extravasation from the tumor, and embolization of the feeding left hepatic artery was performed. After achieving hemostasis, a left hepatic lobectomy was carried out just beneath the reconstructed stomach tube. The patient made an uneventful recovery and remains well after one year. Emergency arterial embolization followed by hepatectomy is an appropriate treatment for patients with spontaneous rupture of liver metastases. (Jpn J Clin Oncol 26: 248-251, 1996)

In Japan, borderline lesions and early-stage hepatocellular carcinoma (HCC) are now histopathologically divided into two subgroups; one includes adenomatous hyperplasia and atypical adenomatous hyperplasia, and the other includes early HCC and early advanced HCC. In order to evaluate the efficacy of transcatheter arterial embolization for treating such lesions, histopathologic studies were done after embolization and resection in 27 patients.The lesions consisted of two adenomatous hyperplasias, one atypical adenomatous hyperplasia, 22 early HCCs, and 13 early advanced HCCs. All patients had chronic liver diseases in nontumorous parenchyma in addition to HCC. For transcatheter arterial embolization, one of the following embolizing materials was used: iodized oil (Lipiodol) alone (n = 4), an emulsion of doxorubicin in Lipiodol (n = 8), and the same emulsion followed by gelatin sponge particles (n = 15).The frequencies of tumor stain on the angiogram and retention of Lipiodol within the tumor were 84% and 94% in overt HCC, 23% and 69% in early advanced HCC, and 9% and 9% in early HCC, respectively. The average size of overt HCC was significantly (p.01) larger than that of early advanced HCC and early HCC. The amount of necrosis induced by embolization relative to the size of the mass was 56% on average in overt HCCs, 14% in early advanced HCCs, and 0% in early HCCs, atypical adenomatous hyperplasias, and adenomatous hyperplasias. Significant differences (p.01) in mean necrosis rate were seen between overt HCCs and early advanced HCCs, between early advanced HCCs and early HCCs, and between overt HCCs and early HCCs. The frequency of Lipiodol retention correlated with mean necrosis rate for tumor. With reference to therapeutic techniques, only for the overt HCCs was a significant difference (p.01) in the mean necrosis rate found between the group that received the emulsion of doxorubicin in Lipiodol and the group that received the emulsion and then particles of gelatin.This study suggests that transcatheter arterial embolization has limited efficacy for treating early-stage HCC and borderline lesions compared with its efficacy for treating overt HCC.

We reviewed computed tomography (CT) in eight patients with sclerosing hepatocellular carcinoma who underwent resection. Dynamic CT was performed 25-40 s (rapid phase) and 5-10 min (late phase) after injection of contrast medium. Most of the lesions were round and homogeneous. Tumors tended to show density equal to the liver. The relative density of the tumors in the rapid phase, however, tended to be higher than in other phases. A peripheral low-density area was absent. Dynamic CT was thus important in the diagnosis of sclerosing hepatocellular carcinoma.

C T during arterial portography (CTAP) is well accepted as an effective technique for examination ofprimary and secondary hepatic tumors, especially in a patient who is a surgical candidate [I]. CT arteriography is considered useful in further defining lesions detected by CTAP [2]. Both examinations are being performed more frequently, and nonpathologic findings in pericystic hepatic areas shown by CfAP [3] and CT arteriography [4] have been reported. Direct inflow of the cystic vein into the intrahepatic portal vein has been suggested as one cause of such findings [5]. However, no nonpathologic findings produced by a hepatic branch artery (ramus profundus) derived from the cystic artery have been reported, to our knowledge.

The efficacy of various imaging procedures used for the diagnosis of small hepatocellular carcinomas (HCCs) (lesions no larger than 3 cm in diameter) was evaluated in a retrospective study of 100 patients. Seven patients with hepatic adenomatous hyperplastic nodules containing HCC foci were also assessed. In 89 patients, the lesion was initially detected during follow-up of chronic liver disease. In 21 patients, it was first diagnosed on the basis of elevated serum alpha-fetoprotein; in the remaining 79 it was diagnosed incidentally with imaging procedures. The overall sensitivities of sonography (84%), CT (84%), and angiography (81%) were compared with those of arterial angiographic CT (82%), portal angiographic CT (91%), lipiodol CT (93%), and intraoperative sonography (96%). The differences in sensitivity between angiography and lipiodol CT (p less than .05) and between intraoperative sonography and the other studies (p less than .01) were statistically significant. In 22 lesions smaller than 1 cm, the sensitivities of lipiodol CT and intraoperative sonography were high (83% and 86%, respectively). Adenomatous hyperplasias containing HCC foci were frequently detected by arterial angiographic CT and intraoperative sonography. These results show that sonography or CT and alpha-fetoprotein are useful in detecting small HCCs in screening programs of patients with chronic liver disease. Lipiodol CT and intraoperative sonography are necessary in patients who are candidates for surgery.

The clinical features of 86 cases of idiopathic portal hypertension, the equivalent of hepatoportal sclerosis in the United States and of noncirrhotic portal fibrosis in India, are presented. This disease is characterized by overt splenomegaly with pancytopenia, portal hypertension, and relatively mild abnormalities in liver function tests. Although differential diagnosis from liver cirrhosis is not always easy, liver histology, laparoscopy, portography, hepatic venography, and measurement of wedged hepatic vein pressure are useful in diagnosis. Prognosis is relatively benign if variceal bleeding is controlled or prevented, and the disease does not progress to cirrhosis. The etiology is still undetermined, but the liver pathology characterized by occlusive changes of the intrahepatic portal radicles, portal and peripheral fibrosis, and irregularly distributed parenchymal atrophies suggests some sort of portal venopathy that causes decreased portal perfusion of peripheral liver parenchyma. These patients with idiopathic portal hypertension were compared with 63 cases of cirrhosis with splenomegaly and 80 cases of cirrhosis without splenomegaly. There was some similarity in hematologic findings between idiopathic portal hypertension and cirrhosis with splenomegaly, but the basic disease process seemed distinctly different. The cause of marked splenomegaly does not seem to be simply congestion, and remains an enigma.

従来の経皮経肝的門脈造影法(旧法)に新たにPTC針やSheath等を用いることによって,門脈への穿刺を安全且つ高い成功率で行い,さらに各種カテーテルの交換を極めて容易に施行しうる改良法(新法)を考案した.各種肝疾患133例に新・旧両法を施行しその各々の成功率,合併症,方法の相違点を検討し得られた門脈像から各門脈流域静脈の位置,分岐角度等をX線的に検討した.成功率は旧法で59.9%であったが新法では90.3%と向上した.一方合併症は両法を通じて胆道造影が28例(21.1%)と最も多く術後開腹術を必要とした例は1例(0.8%)であった.X線的に検討した側副血行路を含む門脈流域静脈の分岐・合流位置及びその角度等を参考にすれば,各静脈(特に側副血行路)への超選択的造影や採血等がさらに容易になり門脈圧亢進症においてその病態生理の研究や閉塞術の治療等に有用と思われる.

病理組織学的に診断された肝内末梢型胆管細胞癌13例の臨床病理学的検討を行った. 超音波で発見された例は85%でそのうち55%が無症状であった. 血液検査ではcarbohydrate antigen19-9の異常高値を50%の症例に認めた. 病理組織学的検討では, 11例が管状～ 乳頭状腺癌で他の2例は嚢胞状腺癌であった. 超音波, computed tomography, 血管造影では腺癌を示唆する所見が得られたが, 特に造影CTでは末梢肝内胆管の拡張 (46%) と, 早期の腫瘍辺縁の染まり (80%), 晩期のperipheral low density (50%) が特徴的であった. 以上より肝内胆管細胞癌の早期診断には50歳以上を対象とした超音波によるスクリーニングが不可欠であると考えられた.

Nineteen patients with soft tissue sarcoma were treated by a combination modality of hyperthermia and radiation or chemotherapy. There were 26 treatment sites. The size of the tumours ranged from 2.5 x 2 cm to 24 x 26 cm. Hyperthermic treatments were given twice a week, for a total of five to 14 sessions. Twenty-one tumours were treated by hyperthermia combined with radiotherapy, 2 Gy daily, five times a week, for a total of 40-78 Gy. Three tumours were treated by hyperthermia and arterial infusion of adriamycin, 100-120 mg in five or six treatments. For the superficial tumours the complete response rate was 40 per cent, and for the deep-seated tumours 6.2 per cent. Among the 12 tumours with no response, nine in which the treatment was evaluated as effective histologically (necrosis of the tumour) and by X-ray CT findings (development of a prominent hypodensity area) were included. Six cases were studied to correlate the X-ray CT findings, angiography and histological findings before and after hyperthermic treatment. The data were also used to interpret the thermal curve. The increased hypodensity area was roughly proportional to the development of necrosis, but there was one case in which hypodensity was not correlated with the necrosis. On the contrary, even in the contrast-enhanced area around the tumour in which the presence of residual tumour was strongly suspected clinically, no tumour cells were visualized. Clinical evaluation of the effect by size of the tumour can be supplemented by CT findings and histology, but should be cautiously adopted.

1977年から1987年までの過去11年間に切除した最大径5cm以下の肝細胞癌235症例を対象に,病巣の発見動機・検出手段について解析した.検索開始動機としては,182症例(77.4%)が基盤に慢性肝障害を有しその定期的経過観察中に病巣を発見された.病巣検出時の血清αfetoprotein (AFP)値は,69症例(29.4%)で正常範囲内であり,400ng/ml以上を示したのは64症例(27.2%)にすぎなかった.病巣を最初に診断した手段は,超音波(US) 112症例(47.7%), AFP 82 (34.9%), CT 25 (10.6%),血管造影及びシンチグラム16 (6.8%)であった.各種診断法における発見手段としての貢献度の推移を検討すると,初期(1977～1981)の32症例中20例(63%)がAFPにて3例(9%)がUSにて拾い上げられていたが,一方後期(1985～1987)ではAFPにて133症例中31例(23%)がUSにて85例(64%)が検出されており,両診断法ともその増減は有意差(p

各種肝疾患155例に経皮経肝門脈造影を施行し,門脈圧,側副血行路径を計測し,更に異なる核種で標識したmacroaggregated albumin (MAA)を用い,うち100例で門脈短絡率,50例で脾静脈短絡率,52例で総短絡率を測定した.その結果,1)総側副血行路径が増大すると,総短絡率も増加する.2)総側副血行路径は,門脈圧の上昇と共に増加して行くが,更に増加しているものでは,むしろ門脈圧は低い.3)門脈圧と総短絡率の間には,y=-0.070xx2+7.63x+180.91 (n=52, r=0.7494, p

Two patients are described in whom percutaneous transhepatic catheterization of the portal vein for a hemodynamic study demonstrated a continuous reversed blood flow in the portal vein, entering into a large collateral. The measurements made of blood pressure in the superior mesenteric, splenic, and left gastric veins, and of ammonia, immunoreactive insulin, and C-peptide in blood taken from these and peripheral veins all indicated reversed portal vein blood flow. The evidence for retrograde portal vein blood flow was obtained in only 2 of 203 patients with cirrhosis in whom portal hemodynamics were studied by the same procedure. Thus, spontaneous reversal of portal vein blood flow does occur, but very rarely.

肝癌に対して肝切除前に肝動脈塞栓術transcatheter arterial embolization (TAE)を施行し,胆管壊死が手術によって確認された2例を報告した.肝切除前TAEは29例に施行されているので,胆管壊死の発生率は7%であった.ただし,これら2例はいずれもgelfoampowderが用いられており,gelfoam powder使用例に限定すると4例中2例,50%の発生率であった.Gelfoam powderは胆管壊死を高率に起こす危険があり,肝の一部分に限局したTAEでなければ,gelfoam powderの使用は禁忌と思われる.なお,塞栓物質につき若干の考察を加えた.

Five patients with hepatocellular carcinoma in the caudate lobe were evaluated. Computed tomography (CT) scan and/or angiography clearly demonstrated multiple intrahepatic metastases in four (80%), and tumor thrombi in the portal vein in two (40%), and in the inferior vena cava in one. Even though there was no recognizable lung metastasis, metastases were found in the orbita in one patient, and in the ribs and thoracic vertebrae in two patients. Four patients died after a mean period of 5.5 months from the initial diagnosis. The mechanism for early invasion into the vessels and multiple intrahepatic metastases of hepatocellular carcinoma arising from the caudate lobe is discussed.

経皮経肝的門脈造影(PTP)像による肝外門脈短絡路を肝硬変症を中心とした83例において検討した.短絡路として左胃静脈,短胃静脈,傍〓静脈,脾静脈末梢より後腹膜へ到る短絡路,脾腎短絡路,左胃静脈より左腎静脈へ到る短絡路,下腸間膜静脈なとど11種類を認めた.疾患により肝外短絡路に特徴的なものは認められなかった.肝外短絡路全体の発達程度をGradeに分けて検討した.門脈圧とGradeは相関が無かった.腹水,吐血の頻度はGradeの高いもの程高率の傾向があったが,吐血はむしろ左胃静脈,短胃静脈の発達程度と良く相関した.脳症との関係は認められなかった.検査成績として血中アルブミン,ビリルビン,プロトロンビン時間, ICG 15分停滞率,と相関は認められなかった.PTP施行時に放射能標識MAA (Macroaggregated albumin)を用いて測定した肝外短絡率はGradeが高い程高値を示した.

今回,著者らは髄膜腫の多発性肝転移に対し,肝切除を施行し得た症例を経験した.症例は33歳の男性で,1978年髄膜腫にて腫瘍の摘出を受け,6年後の1984年,右季肋部痛が出現.精査の結果転移性肝腫瘍が疑われたが,確定診断は得られないまま1984年10月,拡大右葉切除術にて腫瘍を摘出した.組織学的検査では,6年間に切除された脳腫瘍の組織学的所見とほぼ一致したため,髄膜腫の肝転移と診断された.1985年6月,CTにて残肝に再発を認め,同年8月再び肝部分切除を施行した.その後再び頭蓋内にも再発を認め,同年10月に開頭術を施行した.髄膜腫の肝転移に対して治療を目的に肝切除を行ったという報告はなく,教訓的な症例であるため報告した.

A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.

Three cases of cavernous hemangioma of the liver having atypical imaging features are described. In the first case, an 11 x 10 cm hypervascular mass with a central hypovascular area supplied by many large tortuous vessels was demonstrated on angiography, CT, and sonography. The mass had a central cavity that contained fluid. In the second case there was a 2-cm isoechoic mass with a peripheral halo, despite the presence of typical features of hemangioma on angiography. The halo was shown histologically to be fibrous tissue surrounding the tumor. In the third case, a 6.5 x 4.3 cm mass exhibited slight peripheral enhancement on CT but was not detectable by angiography. Histologically, the tumor was hyalinized with only scattered small foci of hemangioma within it.

原発性肝細胞癌に合併する門脈内腫瘍栓 (n=28) の存在診断ならびに進展度診断について, computed tomography (以下, CT) と血管造影所見とを比較検討した. 門脈内腫瘍栓のCT所見として, 1) 門脈拡張を93%(26/28), 2) 門脈内低吸収領域を96%(27/28), 3) 門脈内陰影欠損を43%(12/28), 4) cavernous transformationを43%(12/28), 5) lobar attenuation differenceを50%(14/28), 6) periportal enhancementを25%(7/28) に認めた. そして, 血管造影検査で認められた門脈内腫瘍栓の存在ならびに進展度についてCTを用いた診断率はおのおの100%(28/28), 96%(27/28) であった.