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

肝癌的发生是一个多步骤的过程，从增生结节到早期HCC，通过早期显性HCC，最终发展为晚期显性富血管HCC。在此过程中，结节内血流动力学也发生变化。我们在这项研究中阐明，在癌发生的初始阶段，血流动力学模式显示动脉血管与低血管和门静脉灌注（I型）。在下一步中，动脉和门静脉血液供应减少（II型）。随后，结节内动脉血供增加到等血供（III型），然后增加到血供过多（IV型）。另一种血流动力学转变发生在从初始模式到结节中结节模式（在门脉灌注的少血管背景中具有局部血管斑点的动脉血管分布（V型）。在血流动力学分类为II型和III型的结节中经常观察到脂肪变态。这是由于门脉供应减少和未成熟的动脉新生血管形成导致血液供应相对减少。动脉和门静脉供应减少的病理证据支持的动脉和门静脉血管密度降低在早期分化良好的HCCs.It假设最初和最终证明，结节内的血流动力学转变发生从I型到II型，然后从II型到III型，然后从III型到IV型在人类肝癌发生。该序列已通过5年临床随访证实。这些研究表明，有可能根据通过断层血管成像技术的组合可视化的血液供应来确定结节在恶性转化过程中的阶段。通过这些手段准确检测眼内血流动力学，可以可靠地诊断良性或恶性眼内肿瘤

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