Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography.

Ueda, Kazuhiko; Matsui, Osamu; Kawamori, Yasuhiro; Nakanuma, Yasuni; Kadoya, Masumi; Yoshikawa, Jun; Gabata, Toshifumi; Nonomura, Akitaka; Takashima, Tsutomu

doi:10.1148/radiology.206.1.9423667

Cited by 243 publications

(165 citation statements)

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“…Helical CT and MRI have improved the definition of HCC in the high risk population (20). Blood supply differs between tumor and normal liver due to angiogenesis in a growing tumor (21,22). HCC is often a hypervascular tumor that derives its blood supply primarily from the hepatic artery.…”

Section: Perfusion Imaging For Detection Of Hepatocellular Carcinomamentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases. The advent of multidetector CT has given rise to the acquisition of images with higher quality and accuracy. Multidetector CT has been developed as a noninvasive imaging modality for evaluation of vascular anatomy. It has also made it possible to perform CT angiography of the hepatic vessels. New generation CT systems with multidetector are capable of performing volumetric imaging. These systems provide a single rotational acquisition and almost the whole upper abdomen can be appraised by means of serial rotational acquisitions at a single location in the z-direction. Multidetector CT imaging is used extensively for the preoperative selection of living related liver donors, as well as evaluation of the vascular anatomy of the recipients (1). This imaging technique is also used for the initial evaluation and follow-up of most patients with hepatic metastases, providing valuable information about the number, size, and distribution of hepatic metastases and the presence and extent of extrahepatic disease (1).Perfusion CT imaging permits the qualitative and quantitative assessment of liver perfusion. In perfusion CT, a quantitative tissue perfusion map is obtained from dynamic CT data and displayed using a color scale permitting the quantification of tissue perfusion in absolute units at high spatial resolution (2). Perfusion CT efficiently locates abnormal tissue perfusion which is difficult to detect accurately with conventional CT (3). Functional assessment of the perfusion of normal and pathologic tissues is performed by means of quantitative or semiquantitative parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT), portal liver perfusion (PLP), arterial liver perfusion (ALP) and hepatic perfusion index (HPI). Perfusion CT measures the temporal changes in tissue density through a series of dynamically acquired CT images after intravenous injection of an iodinated contrast material (4, 5). Perfusion CT may be performed quickly and provide valuable data for diagnosis. However, there are some limitations of this method such as long breath-holding for portal flow measurement, separation of arterial and portal blood flow, additional radiation exposure, limited craniocaudal scan range, and standardization of analytic methods (2). In this a...

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Section: Perfusion Imaging For Detection Of Hepatocellular Carcinomamentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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“…The mean periods between the repeated CTHA and CTAP were 383 days (range 40-855 days) in these patients. In addition to CTAP and CTHA, singlelevel dynamic CTHA examination was performed in 20 nodules in 17 patients for the differential diagnosis between hypervascular pseudolesion and HCC [10,11].…”

Section: Patientsmentioning

confidence: 99%

“…As a minimum, 40 s continuous scanning was done without table feed (later phase, late half of the sequential scanning). One image per second was reconstructed [10]. HBV-related cirrhosis 6…”

Section: Patientsmentioning

confidence: 99%

“…Using this method, the drainage pattern of the arterial blood flow into the hypervascular lesion can be visualized in real time. According to the previous reports [9,10], the arterial blood supply into a classical HCC drains into the surrounding hepatic sinusoids or portal venules through the numerous communications between tumor blood sinusoids and hepatic sinusoids and/or portal venules surrounding the tumor, resulting in a ring or corona-like perilesional enhancement at the later phase of single-level dynamic CTHA [9].However, in hypovascular borderline lesions including early HCCs, the main blood supply from the portal vein drains directly into the hepatic veins, and therefore no peri-lesional enhancement is demonstrated. The later phase of single-level dynamic CTHA roughly corresponds to the late phase of CTHA, and therefore the drainage pattern from the hypervascular lesion can also be evaluated on the late phase of CTHA [11,12].…”

Section: Image Evaluationmentioning

confidence: 99%

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Hemodynamics and progression of a hypervascular focus in a borderline lesion of hepatocellular carcinoma: analysis by angiography-assisted CT and histopathology

et al. 2013

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Purpose To investigate the hemodynamics and progression of a hypervascular focus (HF) in a borderline lesion by dual-phase CT during hepatic arteriography (CTHA) and reveal the process of the transformation to hypervascular overt hepatocellular carcinoma (HCC). Materials and methods This study was performed with the approval of our institutional ethics committee, and informed consent for the retrospective usage of clinical materials was obtained from all the patients. The 121 nodules in 76 consecutive patients with liver cirrhosis and chronic hepatitis showing an HF in a borderline lesion on angiography-assisted CT were analyzed. Hemodynamic changes were observed in 24 patients who underwent repeated angiography-assisted CT. Histopathological analysis was conducted in eight nodules. Results HF was classifiable into type A (stain disappeared), B (stain prolonged), C (stain was washed out and corona-like drainage into the outer nodule was seen) and D (stain was washed out and corona-like drainage into the whole outer nodule was seen) on the late phase of CTHA and was seen to progress in this order on follow-up observation. Histopathologically, de-differentiated foci showed significantly higher expression of sinusoidal capillarization and unpaired arteries than background nodules and showed pseudocapsule, compressive and replacing growth at the border of the background nodule. Conclusion HF showed multi-step progression and transformation to hypervascular overt HCC.

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“…However, local recurrence often occurs due to insufficient embolization of tumor and surrounding vessels (2,3,4). In hypervascular HCCs, the blood supply from feeding hepatic arteries drains into the surrounding portal venules and hepatic sinusoids which communicate with tumor blood sinusoids (5,6,7). It has been speculated that particulate TAE often allows the peripheral portion of the HCC to survive probably due to reversed blood flow from the hepatic sinusoids and/or portal venules surrounding the tumor.…”

Section: Introductionmentioning

confidence: 99%

Forcible Intraarterial Injection of a Nonadhesive Liquid Embolic Agent under Microballoon Occlusion: Experimental Study in Swine Liver

Ogi

Matsui

Sanada

et al. 2014

Journal of Vascular and Interventional Radiology

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PURPOSE: To evaluate the feasibility and effectiveness of transcatheter embolization by forcible intra-arterial injection of ethylene vinyl alcohol copolymer (EVAL)/ethanol mixture under microballoon occlusion in comparison with conventional transcatheter arterial embolization methods in non-tumoral swine liver. MATERIALS AND METHODS: Nine swine were divided into three groups: embolization with EVAL/ethanol mixture (EVAL group, n=5), with ethiodized oil (ethiodized oil group, n=2) and with microspheres (microspheres group, n=2). Embolization was performed at the subsegmental hepatic artery. EVAL/ethanol mixture was injected forcibly through a microcatheter with a balloon, which was inflated to prevent backflow of the mixture during the injection. Ethiodized oil or microspheres were injected into the artery using a microcatheter without balloon occlusion. Two animals of the EVAL group were euthanized immediately after embolization, and the distribution of EVAL was assessed microscopically. The remaining seven animals were euthanized four weeks after embolization, and the histopathological changes were assessed. RESULTS: All procedures were technically successful. EVAL occupied greater than 80% of the embolized hepatic arterial, portal venous and sinusoidal lumens. Four weeks after embolization, ischemic coagulation necrosis was observed in the EVAL group. In the ethiodized oil and microspheres groups, parenchymal necrosis was not observed. CONCLUSION: Transcatheter embolization by forcible intra-arterial injection of EVAL/ethanol mixture under micro-balloon occlusion was feasible and achieved the simultaneous embolization of hepatic artery, portal vein and sinusoids in swine liver, resulting in complete necrosis of the embolized segment.

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Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography.

Abstract: The main drainage of hepatocellular carcinoma lesions may be a protal venule.

Cited by 243 publications

References 0 publications

Perfusion CT imaging of the liver: review of clinical applications

Perfusion CT imaging of the liver: review of clinical applications

Hemodynamics and progression of a hypervascular focus in a borderline lesion of hepatocellular carcinoma: analysis by angiography-assisted CT and histopathology

Forcible Intraarterial Injection of a Nonadhesive Liquid Embolic Agent under Microballoon Occlusion: Experimental Study in Swine Liver

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