Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.
Department of Quantum Medical Imaging, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.
Jpn J Radiol. 2019 Mar;37(3):191-208. doi: 10.1007/s11604-019-00817-3. Epub 2019 Feb 2.
Hepatocellular carcinoma (HCC) is heterogeneous in terms of its biological nature. Various factors related to its biological nature, including size, multifocality, macroscopic morphology, grade of differentiation, macro/microvascular invasion, bile duct invasion, intra-tumoral fat and molecular factors, and their value as prognostic imaging biomarkers have been reported. And recently, genome-based molecular HCC classification correlated with clinical outcome has been elucidated. The imaging biomarkers suggesting a less aggressive nature of HCC are smaller size, solitary tumor, smooth margin suggesting small nodular type with indistinct margin and simple nodular type with distinct margin, capsule, imaging biomarkers predicting early or well-differentiated grade, intra-tumoral fat detection, and low fluorodeoxyglucose (FDG) accumulation. The imaging biomarkers suggesting an aggressive HCC nature are larger size, multifocality, non-smooth margin suggesting simple nodular type with extranodular growth, confluent multinodular, and infiltrative type, imaging biomarkers predicting poor differentiation, macrovascular tumor thrombus, predicting microvascular invasion imaging biomarkers, bile duct dilatation or tumor thrombus, and high FDG accumulation. In the genome-based molecular classification, CTNNB-1 mutated HCC shows a less aggressive nature, while CK19/EpCAM positive HCC and macrotrabecular massive HCC show an aggressive one. Better understanding of these imaging biomarkers can contribute to devising more appropriate treatment plans for HCC.
肝细胞癌 (HCC) 在生物学性质上存在异质性。各种与生物学性质相关的因素，包括大小、多灶性、大体形态、分化程度、宏观/微观血管侵犯、胆管侵犯、肿瘤内脂肪和分子因素，以及它们作为预后影像学生物标志物的价值，已经有报道。最近，已经阐明了与临床结果相关的基于基因组的分子 HCC 分类。提示 HCC 侵袭性较低的影像学生物标志物包括较小的大小、单发肿瘤、边缘光滑提示小结节型伴边界不清晰和单纯结节型伴边界清晰、包膜、预测早期或高分化程度的影像学生物标志物、肿瘤内脂肪检测以及氟脱氧葡萄糖 (FDG) 摄取较低。提示 HCC 侵袭性较高的影像学生物标志物包括较大的大小、多灶性、边缘不光滑提示单纯结节型伴结节外生长、融合性多结节型和浸润性型、预测低分化程度的影像学生物标志物、大血管肿瘤血栓、预测微血管侵犯的影像学生物标志物、胆管扩张或肿瘤血栓、以及 FDG 摄取较高。在基于基因组的分子分类中，CTNNB-1 突变型 HCC 侵袭性较低，而 CK19/EpCAM 阳性 HCC 和巨梁型 HCC 侵袭性较高。更好地理解这些影像学生物标志物有助于为 HCC 制定更合适的治疗计划。
