Hayashi M, Matsui O, Ueda K, Kawamori Y, Kadoya M, Yoshikawa J, Gabata T, Takashima T, Nonomura A, Nakanuma Y
Department of Radiology, Kanazawa University School of Medicine, Japan.
AJR Am J Roentgenol. 1999 Apr;172(4):969-76. doi: 10.2214/ajr.172.4.10587130.
The purpose of this study is to evaluate the correlation between the intranodular blood supply revealed by CT during intraarterial injection of contrast medium, mainly using helical CT, and the grade of malignancy of hepatocellular nodules associated with liver cirrhosis as classified by the International Working Party of the World Congress of Gastroenterology.
We studied 201 histologically proven nodules (101 resected and 100 biopsied nodules), including 47 low-grade dysplastic nodules (low-DNs), 56 high-grade dysplastic nodules (high-DNs), 24 well-differentiated hepatocellular carcinomas (wd-HCCs), and 74 moderately or poorly differentiated HCCs (mp-HCCs), in 139 cirrhotic patients. Findings on CT during arterial portography (n = 201) and CT during hepatic arteriography (n = 74) were reviewed and compared with the histologic diagnosis.
CT findings were classified into four types relative to the surrounding liver: type A (isodense), type B (slightly hypodense), type C (partially hypodense), and type D (markedly hypodense) on CT during arterial portography and type I (isodense), type II (hypodense), type III (partially hyperdense), and type IV (hyperdense) on CT during hepatic arteriography. On CT during arterial portography, the distributions of each type were low-DN (n = 47 [A, n = 36; B, n = 8; C, n = 3]), high-DN (n = 56 [A, n = 18; B, n = 20; C, n = 10; D, n = 8]), wd-HCC (n = 24; [B, n = 4; C, n = 13; D, n = 7]), and mp-HCC (n = 74 [D, n = 74]). On CT during hepatic arteriography, the distributions were low-DN (n = 26 [I, n = 18; II, n = 7; III, n = 1]), high-DN (n = 19 [I, n = 6; II, n = 7; III, n = 4; IV, n = 2]), wd-HCC (n = 15 [I, n = 1; III, n = 8; IV, n = 6]), and mp-HCC (n = 14 [IV, n = 14]). We found a statistically significant correlation between the four types and the grade of malignancy of these nodules.
Findings on CT during arterial portography and CT during hepatic arteriography correlated positively with histologic grading when overlap in appearance between dysplastic nodules and HCCs occurred. The concept revealed in this study can apply to diagnoses made on the basis of Doppler sonography, dynamic CT, and MR imaging.
本研究旨在评估在动脉内注射造影剂期间（主要使用螺旋CT）CT显示的结节内血供与世界胃肠病学大会国际工作组织所分类的肝硬化相关肝细胞结节的恶性程度之间的相关性。
我们研究了139例肝硬化患者中的201个经组织学证实的结节（101个切除结节和100个活检结节），包括47个低级别发育异常结节（低级别DN）、56个高级别发育异常结节（高级别DN）、24个高分化肝细胞癌（高分化HCC）和74个中分化或低分化HCC（中低分化HCC）。回顾了动脉门静脉造影期间CT（n = 201）和肝动脉造影期间CT（n = 74）的表现，并与组织学诊断进行比较。
相对于周围肝脏，CT表现分为四种类型：动脉门静脉造影期间CT上的A 型（等密度）、B型（轻度低密度）、C型（部分低密度）和D型（明显低密度），以及肝动脉造影期间CT上的I型（等密度）、II型（低密度）、III型（部分高密度）和IV型（高密度）。在动脉门静脉造影期间CT上，各类型的分布为低级别DN（n = 47 [A，n = 36；B，n = 8；C，n = 3]）、高级别DN（n = 56 [A，n = 18；B，n = 20；C，n = 10；D，n = 8]）、高分化HCC（n = 24；[B，n = 4；C，n = 13；D，n = 7]）和中低分化HCC（n = 74 [D，n = 74]）。在肝动脉造影期间CT上，分布为低级别DN（n = 26 [I，n = 18；II，n = 7；III，n = 1]）、高级别DN（n = 19 [I，n = 6；II，n = 7；III，n = 4；IV，n = 2]）、高分化HCC（n = 15 [I，n = 1；III，n = 8；IV，n = 6]）和中低分化HCC（n = 14 [IV，n = 14]）。我们发现这四种类型与这些结节的恶性程度之间存在统计学上的显著相关性。
当发育异常结节和HCC在外观上出现重叠时，动脉门静脉造影期间CT和肝动脉造影期间CT的表现与组织学分级呈正相关。本研究中揭示的概念可应用于基于多普勒超声、动态CT和磁共振成像所做的诊断。
