Benign and malignant nodules in cirrhotic livers: distinction based on blood supply.

Abstract

The blood supplies of nodular lesions associated with liver cirrhosis were analyzed in vivo with various imaging modalities. The portal blood supply was evaluated with computed tomography (CT) during arterial portography (CTAP); the arterial blood supply was evaluated with hepatic angiography, CT angiography, CT following intraarterial injection of iodized oil, or ultrasound following intraarterial injection of carbon dioxide microbubbles. A total of 84 surgically confirmed hepatocellular carcinomas (HCCs) (less than or equal to 3 cm) and 25 areas of adenomatous hyperplasia (AH) were included in the study. At CTAP, a portal blood supply was seen in 96% of cases of AH and only 6% of HCCs (chi 2, P less than .005). In contrast, an arterial supply greater than that of the surrounding liver was verified in 94% of the HCCs and only 4% of the cases of AH (chi 2, P less than .005). The blood supply of areas of AH with atypical hepatocytes and the blood supply of well-differentiated HCCs (Edmondson grade 1) tended to be intermediate between that of AH without atypia and that of HCC that was Edmondson and Steiner grade 2 or greater. Evaluation of the blood supply of the nodular lesions associated with liver cirrhosis is considered to be useful in the differential diagnosis and treatment of early-stage HCC.

The vascular profile of regenerative and dysplastic nodules of the cirrhotic liver: Implications for diagnosis and classification

“…It has been, therefore, accepted that an abnormal vascular growth could be of diagnostic help to recognize those hepatocellular lesions characterized by an increased risk of neoplastic transformation. 7,10,19 The need for a biological support to the currently available morphological classification is underlined by the recent demonstration that a number of entirely benignlooking LGDNs are monoclonal growths as are a proportion of HGDNs and even HCC. 21 From the present study, we documented that liver nodules, which are considered distinct entities from a morphoclassificative point of view, are characterized by a similar vascular profile.…”

Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma

“…Underestimation of HCC extension results in early recurrence, and imaging procedures to detect tiny HCC lesions prior to treatment are important. Several studies have reported that CTAP is considered to be the most sensitive technique for the detection of hepatic tumors [13,14], however, this technique is costly, invasive and has a high false-positive rate [15,16]. There are several studies indicating that the combined use of CTAP and CTHA for patients with cirrhosis would be helpful in accurate diagnosis of small nodules [19][20][21][22], and is beneficial in the preoperative evaluation of patients with HCC [23].…”

“…Among these imaging techniques, CTAP is one of the most sensitive techniques available for detecting hemodynamic change [13,14], while its distinct disadvantages include invasiveness, high cost and a high rate of false-positive results [15,16]. We have frequently observed that some of the hepatic lesions identified by CTAP and/or CTHA in HCC patients are too small to be diagnosed as additional HCC lesions.…”

Probability of hepatocellular carcinoma of small hepatocellular nodules undetectable by computed tomography during arterial portography

“…31, No. 4,2000 through an antecubital vein. A helical scanning CT was performed with a section thickness of 7 to 10 mm and a table feed speed of 7 to 10 mm/sec.…”