Search

Purpose: To analyze the correlation between intranodular blood supply of borderline lesions (ie, dysplastic nodules or hypovascular well-differentiated hepatocellular carcinoma [HCC] nodules) and their progression to hypervascular classic HCC in cirrhotic livers., Materials and Methods: One hundred seventy-six borderline lesions seen at computed tomography (CT) during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) were evaluated in 49 patients with cirrhosis who underwent repeated CTAP and/or CTHA but no therapy. On the basis of CTAP findings, nodules were categorized as group A (showing almost the same portal venous supply as the surrounding liver), group B (showing decreased portal venous supply) or group C (showing partially absent portal venous supply); on the basis of CTHA findings, nodules were categorized as group I (showing almost the same arterial supply as the liver), group II (showing decreased arterial supply), or group III (showing partially increased arterial supply)., Results: Progression to classic HCC was observed in 29.4% of group A nodules, 53.9% of group B nodules, and 87.9% of group C nodules within 1,000 days; in 58.6% of group I nodules, 12.9% of group II nodules, and 92.2% of group III nodules within 730 days; and in 0% of nodules in group A and I, 28% of nodules in group B and/or II, and 88.7% of nodules in group C and/or III within 730 days., Conclusion: Evaluation of intranodular blood supply was valuable in predicting the prognosis in borderline lesions, except when only arterial blood supply was evaluated.

Purpose: After transcatheter arterial embolization (TAE) with iodized oil (Lipiodol), a relatively dense accumulation of Lipiodol is often seen in the nontumorous liver adjacent to a hypervascular hepatocellular carcinoma (HCC) nodule. We compared this phenomenon with the findings obtained with single-level dynamic CT during hepatic arteriography (SLDCTHA) and presumed its possible mechanism., Methods: Fifty-six patients with HCC underwent hepatic angiography including SLDCTHA followed by segmental or subsegmental TAE with a mixture of an anticancer drug and Lipiodol. We compared the drainage area of the HCC depicted on SLDCTHA with the Lipiodol accumulation in the nontumorous liver adjacent to the HCC on CT after TAE (LpCT)., Results: In 26 of the 56 patients, a definite corona enhancement around the HCC, suggesting the drainage of blood from the tumor into the surrounding liver parenchyma, was seen on the late phase of SLDCTHA. In 17 of these 26 patients (65.4%), LpCT showed a more intense accumulation of Lipiodol in the nontumorous liver adjacent to the HCC that corresponded to the drainage area revealed on SLDCTHA., Conclusion: The drainage of blood from the HCC was considered to be a possible mechanism of the accumulation of Lipiodol in the nontumorous liver adjacent to the HCC.

Purpose: To compare the appearance of small hepatic hemangiomas at nonenhanced and contrast material-enhanced helical computed tomography (CT) with that of small (<3-cm) hypervascular malignant liver tumors and to evaluate the accuracy of multiphase helical CT for differentiating small hemangiomas from small hypervascular malignant tumors., Materials and Methods: Radiologists reviewed multiphase helical CT liver images in 86 patients with 37 hemangiomas and 49 malignant liver tumors. They evaluated lesion type and degree of enhancement for change from arterial to portal venous phase. They rated their confidence in the discrimination of hemangiomas from malignant tumors., Results: At arterial phase CT, enhancement similar to aortic enhancement was observed in 19%-32% of hemangiomas and 0%-2% of malignant tumors; globular enhancement, in 62%-68% and 4%-12%, respectively. At portal venous phase CT, enhancement similar to blood pool enhancement was observed in 43%-54% of hemangiomas and 4%-14% of malignant tumors; globular enhancement, in 46%-49% and 0%-2%, respectively. For all readers and all phases of enhancement, the area under the receiver operating characteristic curves was 0.81-0.87, indicating that inherent accuracy of CT is high and that there was no significant difference (P >.28) in overall accuracy. Readers diagnosed hemangiomas with 47%-53% mean sensitivity with all enhancement phases and diagnosed malignant lesions with 95% mean specificity., Conclusion: Small hemangiomas frequently show atypical appearances at CT. Two-phase helical CT does not improve sensitivity but does improve specificity for differentiating hemangiomas from hypervascular malignant tumors.

Objective: The purpose of this study is to evaluate the correlation between the intranodular blood supply revealed by CT during intraarterial injection of contrast medium, mainly using helical CT, and the grade of malignancy of hepatocellular nodules associated with liver cirrhosis as classified by the International Working Party of the World Congress of Gastroenterology., Subjects and Methods: We studied 201 histologically proven nodules (101 resected and 100 biopsied nodules), including 47 low-grade dysplastic nodules (low-DNs), 56 high-grade dysplastic nodules (high-DNs), 24 well-differentiated hepatocellular carcinomas (wd-HCCs), and 74 moderately or poorly differentiated HCCs (mp-HCCs), in 139 cirrhotic patients. Findings on CT during arterial portography (n = 201) and CT during hepatic arteriography (n = 74) were reviewed and compared with the histologic diagnosis., Results: CT findings were classified into four types relative to the surrounding liver: type A (isodense), type B (slightly hypodense), type C (partially hypodense), and type D (markedly hypodense) on CT during arterial portography and type I (isodense), type II (hypodense), type III (partially hyperdense), and type IV (hyperdense) on CT during hepatic arteriography. On CT during arterial portography, the distributions of each type were low-DN (n = 47 [A, n = 36; B, n = 8; C, n = 3]), high-DN (n = 56 [A, n = 18; B, n = 20; C, n = 10; D, n = 8]), wd-HCC (n = 24; [B, n = 4; C, n = 13; D, n = 7]), and mp-HCC (n = 74 [D, n = 74]). On CT during hepatic arteriography, the distributions were low-DN (n = 26 [I, n = 18; II, n = 7; III, n = 1]), high-DN (n = 19 [I, n = 6; II, n = 7; III, n = 4; IV, n = 2]), wd-HCC (n = 15 [I, n = 1; III, n = 8; IV, n = 6]), and mp-HCC (n = 14 [IV, n = 14]). We found a statistically significant correlation between the four types and the grade of malignancy of these nodules., Conclusion: Findings on CT during arterial portography and CT during hepatic arteriography correlated positively with histologic grading when overlap in appearance between dysplastic nodules and HCCs occurred. The concept revealed in this study can apply to diagnoses made on the basis of Doppler sonography, dynamic CT, and MR imaging.

Purpose: The purpose of our study was to assess the efficacy of single-level dynamic CT during hepatic arteriography (D-CTA) in the differentiation between hypervascular hepatocellular carcinoma (HCC) and hypervascular pseudolesion., Method: D-CTA was performed in nine cases with HCC and nine cases with pseudolesion. Findings on D-CTA were retrospectively analyzed., Results: The transition of the stain of pseudolesion on D-CTA was divided into three phases: (1) inflow of the contrast material into the portal vein within the lesion, (2) lesion staining, and (3) fading out of the stain; that of HCC was divided into four phases: (1) inflow of CM into tumor, (2) tumor staining, (3) inflow of CM into the adjacent liver, and (4) coronal stain of adjacent liver. The coronal stain was seen in all HCCs but not in any pseudolesions., Conclusion: The present study suggest that D-CTA is a helpful option in the differentiation between HCC and pseudolesion.

Purpose: To assess the hemodynamics and the main drainage vessel of hypervascular hepatocellular carcinoma., Materials and Methods: Single-level dynamic computed tomography during hepatic arteriography (CTHA) was performed in 32 patients with hepatocellular carcinoma. Carcinoma was confirmed with histologic (n = 9) or clinical (n = 23) examination results. Single-level CTHA findings were retrospectively analyzed. Histologic specimens from 40 livers with hepatocellular carcinoma were also examined, with special attention to vessels along the rim of the lesion., Results: Contrast material enhancement on single-level CTHA images occurred in four phases: (a) inflow of the contrast material into tumor, (b) tumor enhancement, (c) inflow of the contrast material into adjacent liver, and (d) corona enhancement of adjacent liver. Corona enhancement was seen in all lesions. A bright branching structure in the corona enhancement area, suggestive of a portal venule, was visible at the start of adjacent liver staining in 21 lesions. Continuity between a tumor sinusoid and a tiny vessel in the inner layer of the pseudocapsule was histologically confirmed in 10 of 40 specimens. Continuity between a tiny vessel in the inner layer and a portal vein in the outer layer of the pseudocapsule was confirmed with findings on serial sections from one liver., Conclusion: The main drainage of hepatocellular carcinoma lesions may be a protal venule.

We report a case of segmental hepatic iron deposition in the parenchyma peripheral to a tumor-thrombosed intrahepatic portal vein. On MR imaging, especially fast low-angle shot image, the liver parenchyma was demonstrated as a hypointense area with segmental and wedge-shaped configuration. Absence of portal blood flow may cause such segmental hepatic iron deposition.

Results of orcein staining and findings obtained with non-contrast-medium-enhanced computed tomography (CT) and magnetic resonance (MR) imaging (T1- and T2-weighted images) were compared for 53 histologically confirmed hepatocellular carcinomas (HCCs). HCCs were 5 cm in the largest diameter. Three lesions with diffuse and strong orcein staining were highly attenuating on nonenhanced CT images. Electron x-ray microanalysis of one of them revealed copper. The high attenuation value at nonenhanced CT may have been due to the abundant copper-binding protein in the cancer cells. The difference between orcein staining results and attenuation patterns at CT was statistically significant (chi 2, P less than .001). It could not be concluded that the paramagnetic effects of copper in HCC had an influence on signal intensity on MR images. The difference between orcein staining results and signal-intensity patterns on T1- and T2-weighted images was not statistically significant.

A total of 155 cases of hepatocellular carcinoma smaller than 3 cm in greatest diameter were studied, and the survival rates obtained with various treatment methods were calculated. Patients were divided into an operated group (72 cases), transcatheter arterial embolization (TAE) group (52 cases), percutaneous ethanol injection therapy (PEIT) group (five cases), and a miscellaneous group (26 cases) according to the treatment received. The miscellaneous group included intraarterial chemotherapy, systemic chemotherapy, and no therapy. The survival rates of the operated and TAE groups were significantly higher than those of the miscellaneous group, but the survival rates of the TAE group decreased after two years had passed, and TAE showed limited long-term survival. In the PEIT group, the survival rates after three years were higher than those of the TAE group. TAE is effective for inoperable small HCC, but the indications for PEIT should be considered actively.