Accuracy of angiography in the diagnosis of small hepatocellular carcinoma.

Conventional hepatic arteriography combined with superselective infusion arteriography was carried out in 51 patients with hepatocellular carcinoma smaller than 5 cm, and angiograms of varying phases were analyzed. In cancers smaller than 40 mm, particularly in those smaller than 20 mm, so-called tumor stain in the capillary phase was the only abnormality seen in most but not all cases. Within a tumor stain, there were unstained areas in most cases and histologic examination in resected specimens showed them to be due to either necrosis, fibrosis, or fatty changes. Homogeneity and shape of the stain seemed to be related to growth speed and invasiveness of the cancer. Although overall diagnostic value of angiography for small hepatocellular carcinoma was high, super-superselective infusion hepatic arteriography produced nodular stains in 7 of 11 control cases of nonalcoholic cirrhosis without cancer, making difficult the differential diagnosis between stains due to tumors and those due to hyperplastic nodules of cirrhosis.