Imaging Blood Flow Characteristics of Hepatocellular Carcinoma

Kudo, Masatoshi

doi:10.1159/000048276

Cited by 44 publications

(42 citation statements)

References 42 publications

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“…In observing a series of small HCC lesions undetectable on hepatic angiography, Sonoda et al [29]described them as non-encapsulated, well-differentiated lesions exhibiting a replacing growth pattern, and the existence of intra-nodular portal flow. Hayashi et al [30]and Kudo [31]reported a correlation between changes in the angioarchitecture and blood flow examined by angio-CT and Doppler ultrasonography with respective contrasts.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Dynamic Computed Tomographic and Histopathological Findings in the Diagnosis of Small Hepatocellular Carcinoma

Sakabe

Yamamoto²,

Kubo³

et al. 2004

Dig Surg

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Background/Aims: To determine the characteristic image findings on dynamic computed tomography (CT) for small hepatocellular carcinoma (HCC), we evaluated the correlation of histopathological and radiological findings with respect to the angioarchitecture in small HCCs. Methods: CT and early- and late-phase dynamic CT findings of 80 small HCCs (≤3 cm) were divided into iso-, high, low, and mixed density. We studied the correlation between the imaging findings and the histopathological findings as follows: differentiation grade; presence of fibrous capsule; presence of Glisson’s sheath, and growth pattern. Results: High-density early-phase CT and low-density late-phase CT correlated significantly with moderately/poorly differentiated HCCs, which have a fibrous capsule, no Glisson’s sheath, and an expansive growth pattern. In contrast, well-differentiated HCCs with a Glisson’s sheath and a replacing pattern (early HCC) appeared as iso-dense lesions in the early and late phases. Well-differentiated HCCs (non-early wHCC) demonstrated various density images in the early phase and low-density images in the late phase. Conclusions: Dynamic CT is an economic and simple diagnostic tool for planning treatment of small HCC lesions because of the multistep nature of HCC carcinogenesis and the hemodynamic changes of tumor blood flow.

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Section: Discussionmentioning

confidence: 99%

Correlation between Dynamic Computed Tomographic and Histopathological Findings in the Diagnosis of Small Hepatocellular Carcinoma

Sakabe

Yamamoto²,

Kubo³

et al. 2004

Dig Surg

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“…However, with the exception of haemangiomas with APS and hepatocellular carcinomas, the peritumoural hepatofugal portal flow on CDS is an uncommon finding among various hypervascular tumours, to the best of our knowledge. Hepatofugal portal flow associated with hepatocellular carcinoma is usually seen in cases with tumoural thrombus in the portal vein lumen [14,15]. Therefore, the presence of peritumoural hepatofugal portal flow on CDS in the absence of portal vein thrombus may be an important sign that enhances the suspicion of hepatic haemangioma with APS.…”

Section: Discussionmentioning

confidence: 99%

Colour Doppler sonography of hepatic haemangiomas with arterioportal shunts

Lim

Kim²,

Jeong³

et al. 2012

BJR

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Objectives: To determine the frequency of intratumoural flow and peritumoural hepatofugal portal flow using colour Doppler sonography (CDS) on hepatic haemangiomas with arterioportal shunt (APS), and to investigate possible factors that may affect the capability of CDS to depict such findings. Methods: The study included 45 patients (35 men, 10 women; mean age, 56 years) with hepatic haemangiomas with APS on CT or MRI. Locating the tumour on greyscale sonography, the depth, size and echogenicity of the tumour were evaluated. CT or MR images were evaluated for fatty liver. CDS was performed to determine the presence of intratumoural flow and peritumoural hepatofugal portal flow. Differences in frequency of intratumoural flow and peritumoural hepatofugal portal flow according to the depth, size, echogenicity and fatty liver were evaluated by Student's t-test and Fisher's exact test. Results: On CDS, intratumoural flow and peritumoural hepatofugal portal flow were found in 66.7% and 60%, respectively. The tumour depth was the significant variable that affected the capability of CDS to depict such findings. The frequencies of intratumoural flow and peritumoural hepatofugal portal flow were as high as 88% and 80% for shallow (#30 mm) lesions, and they were 40% and 35% for deep (.30 mm) lesions (p50.0012; p50.0051). Conclusion: CDS can commonly depict intratumoural flow and peritumoural hepatofugal portal flow in patients with hepatic haemangiomas with APS. Therefore, CDS should be routinely performed when an incidental mass is encountered during the screening sonography, especially when the lesion is shallow. Hepatic haemangiomas are frequently found incidentally on screening sonography; therefore, it is important to characterise their sonographic appearances.The value of colour Doppler sonography (CDS) for the evaluation of hepatic haemangioma has been generally underestimated, presumably because most typical haemangiomas have slow intratumoural flow below the sensitivity limits of CDS [1,2]. However, the blood flow pattern of haemangioma differs from tumour to tumour depending on the internal architecture or collective size of the vascular spaces [3], and high-flow haemangiomas, usually (83-89%) accompanying arterioportal shunt (APS), constitute approximately 29-35% of hepatic haemangiomas [4,5]. In contrast to the dissatisfying results in typical slow-flow haemangiomas, it has been reported that, in six cases of angiographically proven haemangiomas with APS, CDS could demonstrate large penetrating arteries, multiple intratumoural flow signals, reversed portal flow within the tumours and hepatofugal portal flow around the tumours [6]. However, the small sample size may have limited the value of this study, and we assume that the capability of CDS to depict the intratumoural flow and peritumoural hepatofugal portal flow in haemangiomas with APS may have depended on various factors.Thus, the purposes of our study were to determine the frequency of intratumoural flow and peritumoural hepatofugal portal flow on CDS of ...

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“…Pathologically, HCC exhibits multistep develop-ment [10,11], and hemodynamically, arterial vascularity increases from hypovascular nodules to isovascular and hypervascular nodules [12,13]. Since the frequency of pulsatile blood flow signals and the flow rate of the artery supply reflect the grade of arterial vascularity, pulsatile blood flow signals with a high flow rate are more frequently detected in hypervascular advanced HCC [14].…”

Section: Afferent Blood Flow Signals In Advanced Hccmentioning

confidence: 99%

“…Hemodynamics show characteristic changes: the state of afferent portal blood with low arterial vascularity loses the portal blood flow, and arterial vascularity gradually increases [12]. The efferent blood flow pathway also changes with the pathological multistep development process and hemodynamic changes ( fig.…”

Section: Changes In the Efferent Blood Flow Pathway During The Multismentioning

confidence: 99%

Afferent and Efferent Vessels of Premalignant and Overt Hepatocellular Carcinoma: Observation by Color Doppler Imaging

Tochio

Kudo²

2004

Intervirology

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Afferent and efferent vessels of premalignant and overt hepatocellular carcinoma (HCC) were analyzed using color Doppler imaging. With afferent blood flow, constant waveform signals reflecting portal inflow are a characteristic finding in dysplastic nodules and early well-differentiated HCC. Among advanced HCCs lacking portal blood flow, inflow of arterial pulsatile blood flow signals is characteristic for advanced HCC with increased arterial vascularity. Efferent blood flow enters the hepatic vein of the lowest pressure system in dysplastic nodules and early well-differentiated HCC with afferent portal blood flow. Analysis of waveforms of efferent blood flow signals in advanced HCC detects in the opposite direction adjacent to an accompanying afferent arterial pulsatile blood flow signal. In conclusion, during multistep human hepatocarcinogenesis hemodynamics show characteristic changes; the state of afferent portal blood with low arterial vascularity loses the portal blood flow, and arterial vascularity gradually increases. The efferent blood flow pathway also changes with the pathological multistep developement process.

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Imaging Blood Flow Characteristics of Hepatocellular Carcinoma

Cited by 44 publications

References 42 publications

Correlation between Dynamic Computed Tomographic and Histopathological Findings in the Diagnosis of Small Hepatocellular Carcinoma

Correlation between Dynamic Computed Tomographic and Histopathological Findings in the Diagnosis of Small Hepatocellular Carcinoma

Colour Doppler sonography of hepatic haemangiomas with arterioportal shunts

Afferent and Efferent Vessels of Premalignant and Overt Hepatocellular Carcinoma: Observation by Color Doppler Imaging

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