Matsui Osamu, Kobayashi Satoshi, Sanada Junichiro, Kouda Wataru, Ryu Yasuji, Kozaka Kazuto, Kitao Azusa, Nakamura Koichi, Gabata Toshifumi
Department of Radiology, Graduate School of Medical Science, Kanazawa University, Japan.
Abdom Imaging. 2011 Jun;36(3):264-72. doi: 10.1007/s00261-011-9685-1.
To understand the hemodynamics of hepatocellular carcinoma (HCC) is important for the precise imaging diagnosis and treatment, because there is an intense correlation between their hemodynamics and pathophysiology. Angiogenesis such as sinusoidal capillarization and unpaired arteries shows gradual increase during multi-step hepatocarcinogenesis from high-grade dysplastic nodule to classic hypervascular HCC. In accordance with this angiogenesis, the intranodular portal supply is decreased, whereas the intranodular arterial supply is first decreased during the early stage of hepatocarcinogenesis and then increased in parallel with increasing grade of malignancy of the nodules. On the other hand, the main drainage vessels of hepatocellular nodules change from hepatic veins to hepatic sinusoids and then to portal veins during multi-step hepatocarcinogenesis, mainly due to disappearance of the hepatic veins from the nodules. Therefore, in early HCC, no perinodular corona enhancement is seen on portal to equilibrium phase CT, but it is definite in hypervascular classical HCC. Corona enhancement is thicker in encapsulated HCC and thin in HCC without pseudocapsule. To understand these hemodynamic changes during multi-step hepatocarcinogenesis is important, especially for early diagnosis and treatment of HCCs.
了解肝细胞癌（HCC）的血流动力学对于精确的影像诊断和治疗至关重要，因为其血流动力学与病理生理学之间存在密切关联。在从高级别发育异常结节到经典高血供HCC的多步骤肝癌发生过程中，诸如窦状毛细血管化和不成对动脉等血管生成呈逐渐增加趋势。与这种血管生成相一致，结节内门静脉供血减少，而结节内动脉供血在肝癌发生早期首先减少，然后随着结节恶性程度的增加而平行增加。另一方面，在多步骤肝癌发生过程中，肝细胞结节的主要引流血管从肝静脉变为肝血窦，然后变为门静脉，这主要是由于结节内肝静脉消失所致。因此，在早期HCC中，门静脉期至平衡期CT上未见结节周围晕圈强化，但在高血供经典HCC中则明确可见。包膜型HCC的晕圈强化较厚，无假包膜的HCC的晕圈强化较薄。了解多步骤肝癌发生过程中的这些血流动力学变化非常重要，尤其是对于HCC的早期诊断和治疗。
