Imaging Analysis and Molecular Mechanism of angio architectural Change of the Tumor During Multistep Human Hepatocarcinogenesis

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Hepatocarcinogenesis is a multistep process, evolving from a hyperplastic nodule to early HCC, through early overt HCC, eventually to advanced overt hypervascular HCC. During this process, changes in intranodular hemodynamics also occu. We clarified in this research that at the initial phase of carcinogenesis, the hemodynamic pattern shows arterial vascularity with hypovascular and portal perfusion(type I). In the next step, both arterial and portal blood supplies decrease(type II). Subsequently, intranodular arterial vascularity increases to isovascularity(type III), and then to hypervascularity(type IV). Another hemodynamic transition occurs from the initial pattern to nodule-in-nodule pattern(arterial vascularity with regional vascular spots in a hypovascular background of portal perfusiai(type V).Fatty metamorphosis is observed frequently in the nodules classified hemodynamically in type II and III. This is attributed to a relative decrease in the blood supply due to a diminished portal supply and immature arterial neovascularization. Decreased arterial and portal supplies are supported by pathological evidence for decreased densities of arterial and portal vessels in early-stage well-differentiated HCCs.It was hypothesized initially and finally demonstrated that an intranodular hemodynamic transition occurs from type I to type II and then from type II to type III, before proceeding from type III to type IV during human hepatocarcinogenesis. This sequence has been confirmed by a 5-year clinical follow-up. Such studies have suggested the possibility of determining the stage of a nodule in the process of malignant transformation based on blood supplies visualized by a combination of tomographic vascular imaging techniques. An accurate detection of intraocular hemodynamics by these means lead to a reliable diagnosis, whether it is benign or malignant