Correlation between the blood supply and grade of malignancy of hepatocellular modules associated with liver cirrhosis: Evaluation by CT during intraarterial injection of contrast medium
Correlation between the blood supply and grade of malignancy of hepatocellular modules associated with liver cirrhosis: Evaluation by CT during intraarterial injection of contrast medium
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DOI：
10.2214/ajr.172.4.10587130
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发表时间：
1999-04-01
影响因子：
5
通讯作者：
Nakamura, Y
中科院分区：
文献类型：
--
作者：
Hayashi, M;Matsui, O;Nakamura, Y
objective.本研究的目的是评估动脉内注射造影剂过程中CT显示的结节内血供（主要使用螺旋CT）与肝硬化相关肝细胞结节恶性程度（由世界胃肠病学大会国际工作组分类）之间的相关性。我们研究了139例肝硬化患者的201个组织学证实的结节（101个切除和100个活检结节），包括47个低度异型增生结节（low-DN），56个高度异型增生结节（high-DN），24个高分化肝细胞癌（wd-HCC）和74个中分化或低分化HCC（mp-HCC）。回顾性分析201例门脉动脉造影和74例肝动脉造影的CT表现，并与病理诊断进行比较。CT表现相对于周围肝脏分为4型：动脉门脉造影CT表现为A型（等密度）、B型（稍低密度）、C型（部分低密度）和D型（明显低密度）;肝动脉造影CT表现为I型（等密度）、II型（低密度）、III型（部分高密度）和IV型（高密度）。动脉门脉造影CT上各型分布均为低DN型（n = 47 [A，n = 36; B，n = 8; C，n = 3]），高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]）和mp-HCC（n = 74 [D，n = 74]）。肝动脉造影CT表现为低DN分布（n = 26 [I，n = 18; II，n = 7; III，n = 1]），高DN（n = 19 [I，n = 6; II，n = 7; III，n = 4; IV，n = 2]），wd-HCC（n = 15 [1，n = 1; III，n = 8，IV，n = 6]）和mp-HCC（n = 14 [IV，n = 14]）我们发现四种类型与这些结节的恶性程度之间存在统计学显著相关性。当异型增生结节与HCC重叠时，动脉门脉造影和肝动脉造影的CT表现与组织学分级呈正相关。本研究揭示的概念可应用于多普勒超声、动态CT和MR成像的基础上作出的诊断。
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.