Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multi-step hepatocarcinogenesis
Hepatocelluar nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multi-step hepatocarcinogenesis
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DOI：
10.1007/s00261-011-9685-1
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发表时间：
2011-06-01
影响因子：
--
通讯作者：
Gabata, Toshifumi
中科院分区：
文献类型：
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作者：
Matsui, Osamu;Kobayashi, Satoshi;Gabata, Toshifumi
肝细胞癌（HCC）血流动力学与病理生理密切相关，了解其血流动力学对其精确的影像学诊断和治疗具有重要意义。在肝癌从高度发育不良结节到典型高血管性肝癌的多阶段发生过程中，血管新生如窦状毛细血管化和不成对动脉逐渐增加。与血管生成相一致，在肝癌发生的早期，结节内门静脉供应减少，而结节内动脉供应首先减少，然后随着结节恶性程度的增加而增加。另一方面，肝细胞结节的主要引流血管在多步肝癌发生过程中由肝静脉变为肝窦，再变为门静脉，这主要是由于肝静脉从结节中消失所致。因此，在早期HCC中，门脉到平衡期CT未见结节周围冠状强化，但在典型的高血管HCC中是明确的。包膜HCC的冠状强化较厚，无假包膜HCC的冠状强化较薄。了解多步骤肝癌发生过程中的这些血流动力学变化是重要的，特别是对hcc的早期诊断和治疗。
To understand the hemodynamics of hepatocellular carcinoma (HCC) is important for the precise imaging diagnosis and treatment, because there is an intense correlation between their hemodynamics and pathophysiology. Angiogenesis such as sinusoidal capillarization and unpaired arteries shows gradual increase during multi-step hepatocarcinogenesis from high-grade dysplastic nodule to classic hypervascular HCC. In accordance with this angiogenesis, the intranodular portal supply is decreased, whereas the intranodular arterial supply is first decreased during the early stage of hepatocarcinogenesis and then increased in parallel with increasing grade of malignancy of the nodules. On the other hand, the main drainage vessels of hepatocellular nodules change from hepatic veins to hepatic sinusoids and then to portal veins during multi-step hepatocarcinogenesis, mainly due to disappearance of the hepatic veins from the nodules. Therefore, in early HCC, no perinodular corona enhancement is seen on portal to equilibrium phase CT, but it is definite in hypervascular classical HCC. Corona enhancement is thicker in encapsulated HCC and thin in HCC without pseudocapsule. To understand these hemodynamic changes during multi-step hepatocarcinogenesis is important, especially for early diagnosis and treatment of HCCs.