Sequential Hemodynamic Change in Hepatocellular Carcinoma and Dysplastic Nodule: CT Angiography and Pathologic Correlation

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The purpose of this study was to clarify the hemodynamic changes associated with hepatocarcinogenesis using CT angiography. Eighty-six hepatocellular lesions in 49 patients who underwent CT with both hepatic arteriography and arterioportography were pathologically confirmed. These images were compared with lesion-to-liver vascular ratios of cumulative arteries, preexisting hepatic arteries, and portal veins in resected specimens. Lesions were classified into five groups according to intranodular hemodynamics determined by CT hepatic arteriography and CT during arterioportography; group 1: isoattenuating on both; group 2: hypoattenuating on CT hepatic arteriography and isoattenuating on CT during arterioportography; group 3: hypoattenuating on both; group 4: isoattenuating on CT hepatic arteriography and hypoattenuating on CT during arterioportography; and group 5: hyperattenuating on CT hepatic arteriography and hypoattenuating on CT during arterioportography. .Among 86 lesions, there were 7 low-grade dysplastic nodules, 8 high-grade dysplastic nodules, 14 well-differentiated hepatocellular carcinomas, 45 moderately differentiated hepatocellular carcinomas, and 12 poorly differentiated hepatocellular carcinomas. The lesions were classified into group 1 (n=5), group 2 (n=13), group 3 (n=6), group 4 (n=2), and group 5 (n=60). Intranodular hemodynamics was significantly correlated with pathologic gradings (p<.001). For correlations between combinations of the groups and patnologic gradings, the order "groups 1-2-3-4-5" was the most significant (p<.001). During hepatocarcinogenesis, most hepatocellular nodules show deterioration of arterial blood flow before loss of portal blood flow. Vascular imaging of hepatic nodules may predict malignant pathology via the early loss of hepatic arterial flow prior to portal flow changes.