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

本研究的目的是利用CT血管造影来阐明与肝癌发生相关的血流动力学变化。49例患者的86个肝细胞病变均经肝动脉造影和肝动脉门脉造影的CT检查证实。这些图像与累积动脉、既存肝动脉和切除标本中门静脉的病变与肝血管比率进行比较。根据CT肝动脉造影和动脉门静脉造影期间CT确定的结节内血流动力学，将病变分为5组;第1组：均为等衰减;第2组：CT肝动脉造影低衰减和动脉门静脉造影期间CT等衰减;第3组：均为低衰减;第4组：CT肝动脉造影等衰减和动脉门静脉造影期间CT低衰减;第5组：CT肝动脉造影呈高密度，动脉门静脉造影呈低密度。86个病灶中，低度异型增生结节7个，高度异型增生结节8个，高分化肝癌14个，中分化肝癌45个，低分化肝癌12个。病变分为第1组（n=5）、第2组（n=13）、第3组（n=6）、第4组（n=2）和第5组（n=60）。结节内血流动力学与病理分级显著相关（p<0.001）。对于各组组合与病理分级之间的相关性，“组1-2-3-4-5”的顺序最显著（p<0.001）。在肝癌发生过程中，大多数肝细胞结节在门脉血流丧失之前表现出动脉血流的恶化。肝结节的血管成像可以通过在门脉血流改变之前肝动脉血流的早期损失来预测恶性病理。

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.