Tsurusaki Masakatsu, Sofue Keitaro, Murakami Takamichi, Tanigawa Noboru
Department of Radiology, Kansai Medical University Medical Center, Moriguchi 570-8503, Osaka, Japan.
Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan.
Cancers (Basel). 2024 Dec 31;17(1):101. doi: 10.3390/cancers17010101.
The liver is supplied by a dual blood flow system consisting of the portal vein and hepatic artery. Imaging techniques for diagnosing hepatocellular carcinoma (HCC) have been developed along with blood flow imaging, which visualizes the amount of arterial and portal blood flow. The diagnosis of HCC differentiation is important for early-stage liver cancer screening and determination of treatment strategies. Dynamic computed tomography/magnetic resonance imaging (MRI) includes blood flow imaging and MRI with contrast-enhanced ultrasound and liver-specific contrast agents are used in combination. In addition, unlike the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), which is the standard for determining treatment efficacy for solid tumors in general, tumor necrosis is generally considered a treatment effect in HCC, and the modified RECIST and Liver Cancer Direct Effectiveness Criteria (RECICL) are widely used. Familiarity with the definitions, criteria, and potential challenges of the mRECIST and RECICL is essential for their effective application in clinical practice. This review integrates the latest advancements in systemic treatments and imaging techniques, including the role of LI-RADS and updates on molecular-targeted therapies such as regorafenib, supported by some systematic review and meta-analysis.
肝脏由门静脉和肝动脉组成的双重血流系统供血。随着血流成像技术的发展，用于诊断肝细胞癌（HCC）的成像技术也得以发展，血流成像可显示动脉和门静脉血流的量。HCC分化的诊断对于早期肝癌筛查和治疗策略的确定很重要。动态计算机断层扫描/磁共振成像（MRI）包括血流成像，并且将对比增强超声和肝脏特异性造影剂的MRI联合使用。此外，与一般用于确定实体瘤治疗疗效的标准《实体瘤疗效评价标准》（RECIST）（第1.1版）不同，在HCC中肿瘤坏死通常被视为一种治疗效果，改良RECIST和肝癌直接疗效标准（RECICL）被广泛使用。熟悉mRECIST和RECICL的定义、标准及潜在挑战对于它们在临床实践中的有效应用至关重要。本综述整合了全身治疗和成像技术的最新进展，包括LI-RADS的作用以及一些系统评价和荟萃分析支持的瑞戈非尼等分子靶向治疗的更新情况。
