The multistep process of hepatocarcinogenesis in cirrhosis with imaging correlation

Abstract

Hepatocarcinogenesis in the cirrhotic liver has recently become a subject of intense investigation. The development of hepatocellular nodules demonstrating varying degrees of cellular and architectural atypia suggests that these nodular lesions represent a pathway of carcinogenesis in cirrhosis of different etiologies. This pathway involves processes, such as capillarization and neoangiogenesis, leading to a gradual change in blood supply from portal to arterial, as a dysplastic nodule becomes hepatocellular carcinoma. These changes in intranodular blood supply create different enhancement patterns in the two phases of liver circulation after an intravenous contrast injection on multi-phase helical CT or dynamic gadolinium-enhanced MRI. This article reviews the current concepts regarding the vascular changes occurring in dysplastic nodules in the multistep process of hepatocarcinogenesis, along with the associated imaging manifestations. Some practical issues and dilemmas regarding the follow-up and biopsy of these lesions are also discussed.

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

“…It is widely believed that HCC can develop in cirrhotic livers from premalignant lesions or dysplastic nodules via multi-step carcinogenesis. [74][75][76] During this process, a pathological feature called early HCC is clearly distinguished from conventional hypervascular HCC 77,78 (Fig. 8a-e).…”

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

“…These studies have relied on biopsy or surgical resection specimens for evaluation of the accuracy of imaging detection and characterization of cirrhotic nodules, the resulting bias being toward positive study results. Because some dysplastic nodules [27,28] and lesions of focal nodular hyperplasia [29,30] also become enhanced during the hepatic arterial phase, the presence of arterial phase enhancement is not specific for the presence of malignancy. In addition, arterial phase enhancement can be seen with hemangiomas, arterial-portal venous shunts, and aberrant venous drainage [31,32].…”

Assessment of hemodynamics in precancerous lesion of hepatocellular carcinoma: Evaluation with MR perfusion

“…A total of 46 nodules were located by MR imaging and autopsy, including 22 dysplastic nodules (DN), 9 regenerative nodules (RN), 10 (Table 1).…”

“…T he imaging characteristics of DN have been previously reported [10][11][12] . However, the diagnosis of precancerous lesions is still difficult because of the overlapping between DN and RN, DN and early HCC on ultrasound, CT and MRI.…”