Hemodynamic and sinusoidal function change during multistep hepatocarcinogenesis : evaluation by contrast harmonic imaging

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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 occur. 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 perfusion (type V).Pure arterial phase imaging has been developed by a development of several technologies including Raw data management technology and accumulation image technology (MIP image). By this method, separate analysis of intranodular, portal flow from arterial flow has been possible, which is a novel technique. This was not possible by CT or MRI. Hepatocellular carcinoma, dysplastic nodule, and nodule-in-nodule type HCC can be successfully diagnosed by using this technique, pure arterial phase imaging.