Correlation between the intranodular blood supply and the grade of malignancy of hepatocellular nodules associated with liver cirrhosis

本研究的目的是分析动脉门脉造影(CTAP)和肝动脉造影(CTA)CT评价的结节内血供与日本肝癌研究组肝细胞结节恶性程度的相关性，并与自然病程相比较，评价CTAP和/或CTA对肝细胞结节恶性程度诊断的适宜性。对139例患者201个结节的CTAP和CTA表现与组织学诊断进行对照分析。在CTAP上，腺瘤性增生(AH)主要表现为与周围肝几乎相同的门静脉供血(A组)，不典型AHS(AAH)门脉供血减少(B组)，高分化型肝细胞癌(wd-HCC)部分门静脉供血(C组)，模型性或低分化肝细胞癌(MP-HCC)门静脉供血不足(D组)。Ab…的比率与其他组相比，各组织学组中更多的OVE组具有统计学意义。CTA表现也分为4组，动脉血供相同(a组)，动脉血供减少(b组)，动脉血供部分增加(c组)，动脉血供增加(d组)。有AHS组、AAHS组、WD-HCCs组的趋势，但无统计学意义。四组间结节的恶性程度由低到高依次为A、B、C、D和a、b、c、d，差异有统计学意义。比较各组176个结节的恶变率。癌变定义为：一半以上的结节在CTA上染色或在CTAP上显示为灌注缺陷。随着CTAP表现恶性程度的增加，恶变率增加。另一方面，根据CTA结果分组的分级与预后之间存在差异，因为A组包括两种不同的情况，即AH和AAH或EWD-HC。联合应用CTAP和CTA，24个月内A组和A组结节无恶变，B组和B组结节恶变30%，C型或C型结节恶变90%以上。这一结果与CTAP和CTA诊断的恶性程度有很好的一致性。CT动脉造影对判断结节的恶性程度、明确人肝癌的发生机制和确定治疗方法具有重要价值。较少

The purpose of this study is to analyze the correlation between intranodular blood supply evaluated by CT during arterial portography (CTAP) and CT during hepatic arteriography (CTA) and the grade of malignancy of hepatocytic nodules associated with liver cirrhosis based on the classification by Liver Cancer Study Group of Japan, and to evaluate the appropriateness of the diagnosis of grade of malignancy by CTAP and/or CTA in comparison with the natural course of the nodules. CTAP and CTA findings were compared to the histological diagnosis among 201 nodules in 139 cirrhotic patients. On CTAP, adenomatous hyperplasia (AH) mainly demonstrated almost the same portal supply relative to the surrounding liver (group A), atypical Ahs (AAH) decreased portal flow (group B), well-differentiated hepatocellular carcinomas (wd-HCC) partial absence of portal supply (group C), and modelately or poorly differentiated HCCs (mp-HCC) absence of portal supply (group D), respectively. The ratios of the ab … More ove groupes in each histological groups were statistically significant compared to those in the other groups. CTA findings were also devided into four groups, the same arterial supply (group a), decreased arterial supply (group b), partially increased arterial supply (group c), and increased arterial supply (group d). There was a tendency that Ahs showed group a, AAHs group b, wd-HCCs group c, without statistically significance. All of mp-HCCs demonstrated group d. There was a statistically significant correlation between the four groups and the grades of nodules, in the order of A, B, C, D and a, b, c, d from low to high grade of malignancy. The malignant transformation ratios of the nodules in each groups in 176 nodules were compared. Malignant transformation was defined as more than half of a nodule was stained on CTA or was shown as perfusion defect on CTAP. With increase in grade of malignancy of CTAP findings, malignant transformation ratio was increased. On the other hand, there was a discrepancy between the grade in the groups classified by CTA findings and their prognosis, because, group a includes two different conditions, AH and AAH or ewd-HCCs. On the combination of CTAP and CTA, no malignant transformation was seen in the nodules with group A and a, 30% malignant transformation in the nodules with group B or b, and more than 90% malignant transformation in the nodules with type C or type c during 24 months. This result well corresponded with the grade of malignancy diagnosed by CTAP and CTA. The evaluation of blood supply by arteriographic CT was considered to be valuable to estimate the grade of malignancy of these nodules, to make clear human hepatocarcinogenesis, and to determine the treatment method. Less