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，从增生性结节到早期HCC，再到早期显性HCC，最终到晚期显性高血管性HCC。在此过程中，也会发生结节内血流动力学的变化。我们在这项研究中阐明，在癌变的初始阶段，血流动力学模式显示动脉血管丰富，伴低血管和门静脉灌注（I型）。在接下来的步骤中，动脉和门静脉血液供应减少（II型）。随后，结节内动脉血管充血增加到等血管充血（III型），然后增加到血管充血（IV型）。另一种血流动力学转变发生于从初始型到结节中型（门静脉灌注低血管背景下动脉血管增生伴区域性血管斑点）。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。这是由于门静脉供应减少和动脉新生血管不成熟导致的血液供应相对减少。早期高分化hcc中动脉和门静脉血管密度降低的病理证据支持动脉和门静脉供应减少。最初的假设和最终证明，在人类肝癌发生过程中，从I型到II型，然后从II型到III型，在从III型到IV型之前，发生了一种结节内血流动力学转变。5年的临床随访证实了这一序列。这些研究表明，在恶性转化过程中，基于结合断层血管成像技术可视化的血液供应来确定结节分期的可能性。通过这些手段准确检测眼内血流动力学，可得出可靠的诊断，无论其是良性还是恶性

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