Progression to Hypervascular Hepatocellular Carcinoma: Correlation with Intranodular Blood Supply Evaluated with CT during Intraarterial Injection of Contrast Material

Hayashi, Makiko; Matsui, Osamu; Ueda, Kazuhiko; Kawamori, Yasuhiro; Gabata, Toshifumi; Kadoya, Masumi

doi:10.1148/radiol.2251011298

Cited by 213 publications

(149 citation statements)

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“…In conclusion, results of this study show that a number of truly hypovascular HCCs do exist, as previously shown, 43,44 particularly in nodules of 1 to 2 cm, and a not insignificant number of nonmalignant hypovascular lesions may also be found in livers with cirrhosis. 4 These lesions, together with those nodules that appear to be hypervascular with only one technique, without a pathological diagnosis of malignancy, represent an area of clinical uncertainty that accounts for at least 39% of newly diagnosed small nodules in cirrhosis.…”

Section: The Problem Of Nodules Without Confirmation Ofsupporting

confidence: 86%

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

et al. 2005

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In a prospective study, we examined the impact of arterial hypervascularity, as established by the European Association for the Study of the Liver (EASL) recommendations, as a criterion for characterizing small (1-3 cm) nodules in cirrhosis. A total of 72 nodules (1-2 cm, n ‫؍‬ 41; 2.1-3 cm, n ‫؍‬ 31) detected by ultrasonography in 59 patients with cirrhosis were included in the study. When coincidental arterial hypervascularity was detected at contrast perfusional ultrasonography and helical computed tomography, the lesion was considered to be hepatocellular carcinoma (HCC) according to EASL criteria. When one or both techniques showed negative results, ultrasound-guided biopsy was performed. In cases with negative results for malignancy or highgrade dysplasia, biopsy was repeated when an increase in size was detected at the 3-month follow-up examination. Coincidental hypervascularity was found in 44 of 72 nodules (61%; 44% of 1-2-cm nodules and 84% of 2-3-cm nodules). Fourteen nodules (19.4%) had negative results with both techniques (hypovascular nodules). Biopsy showed HCC in 5 hypovascular nodules and in 11 of 14 nodules with hypervascularity using only one technique. All nodules larger than 2 cm finally resulted to be HCC. Not satisfying the EASL imaging criteria for diagnosis were 38% of HCCs 1 to 2 cm (17% hypovascular) and 16% of those 2 to 3 cm (none hypovascular). In conclusion, the noninvasive EASL criteria for diagnosis of HCC are satisfied in only 61% of small nodules in cirrhosis; thus, biopsy frequently is required in this setting. Relying on imaging techniques in nodules of 1 to 2 cm would miss the diagnosis of HCC in up to 38% of cases. Any nodule larger than 2 cm should be regarded as highly suspicious for HCC. (HEPATOLOGY 2005;42: 27-34.)

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Section: The Problem Of Nodules Without Confirmation Ofsupporting

confidence: 86%

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

et al. 2005

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“…The most sensitive modality capable of objectively depicting the early carcinogenesis process among currently available imaging systems is (1) CTAP, followed by (2) CTHA [239,240], (3) CEUS [241][242][243], and (4) SPIO-enhanced MRI [225,244]. Portal blood flow may be maintained in some cases of DN and early HCC but reduced in other nodules, although the pathology remains because of early HCC, in which arterial blood flow has not yet increased.…”

Section: Diagnostic Algorithm Of Hypovascular Hccmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…In imaging analysis, a ''borderline lesion'' was defined as a nodule showing hypodensity on CTHA indicating decreased intranodular arterial supply and isodensity or slight hypodensity on CTAP indicating the same or decreased but not absent intranodular portal supply relative to the surrounding liver parenchyma [7,8]. When early phase of a CTHA image indicated a region of hyperdensity relative to the surrounding area in the nodule and its largest diameter was not larger than half of the largest diameter of the entire borderline lesion measured on axial images, it was defined as an HF [7,8].…”

Section: Definition Of a Hf In Borderline Lesionsmentioning

confidence: 99%

“…This focus grows to finally occupy the entire nodule, resulting in progression to a more malignant and entirely hypervascular HCC (so-called classic HCC) [8]. In addition, in accordance with the progression of these changes, the drainage vessels change from hepatic veins in borderline lesions to hepatic sinusoids and then to portal veins in hypervascular classic HCCs [9].…”

Section: Introductionmentioning

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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Progression to Hypervascular Hepatocellular Carcinoma: Correlation with Intranodular Blood Supply Evaluated with CT during Intraarterial Injection of Contrast Material

Abstract: Evaluation of intranodular blood supply was valuable in predicting the prognosis in borderline lesions, except when only arterial blood supply was evaluated.

Cited by 213 publications

References 15 publications

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

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

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