Ueda K, Matsui O, Kawamori Y, Nakanuma Y, Kadoya M, Yoshikawa J, Gabata T, Nonomura A, Takashima T
Department of Radiology, Kanazawa University School of Medicine, Japan.
Radiology. 1998 Jan;206(1):161-6. doi: 10.1148/radiology.206.1.9423667.
To assess the hemodynamics and the main drainage vessel of hypervascular hepatocellular carcinoma.
Single-level dynamic computed tomography during hepatic arteriography (CTHA) was performed in 32 patients with hepatocellular carcinoma. Carcinoma was confirmed with histologic (n = 9) or clinical (n = 23) examination results. Single-level CTHA findings were retrospectively analyzed. Histologic specimens from 40 livers with hepatocellular carcinoma were also examined, with special attention to vessels along the rim of the lesion.
Contrast material enhancement on single-level CTHA images occurred in four phases: (a) inflow of the contrast material into tumor, (b) tumor enhancement, (c) inflow of the contrast material into adjacent liver, and (d) corona enhancement of adjacent liver. Corona enhancement was seen in all lesions. A bright branching structure in the corona enhancement area, suggestive of a portal venule, was visible at the start of adjacent liver staining in 21 lesions. Continuity between a tumor sinusoid and a tiny vessel in the inner layer of the pseudocapsule was histologically confirmed in 10 of 40 specimens. Continuity between a tiny vessel in the inner layer and a portal vein in the outer layer of the pseudocapsule was confirmed with findings on serial sections from one liver.
The main drainage of hepatocellular carcinoma lesions may be a protal venule.
评估高血供肝细胞癌的血流动力学及主要引流血管。
对32例肝细胞癌患者进行了肝动脉造影期间的单层动态计算机断层扫描（CTHA）。通过组织学检查结果（n = 9）或临床检查结果（n = 23）确诊为癌。对单层CTHA的结果进行回顾性分析。还检查了40例肝细胞癌肝脏的组织学标本，特别关注病变边缘的血管。
单层CTHA图像上的对比剂增强分为四个阶段：（a）对比剂流入肿瘤，（b）肿瘤增强，（c）对比剂流入相邻肝脏，（d）相邻肝脏的冠状增强。所有病变均可见冠状增强。在21个病变中，在相邻肝脏染色开始时，冠状增强区域可见一个明亮的分支结构，提示门静脉小分支。在40个标本中的10个标本中，组织学证实肿瘤血窦与假包膜内层的微小血管之间存在连续性。从一个肝脏的连续切片结果证实了假包膜内层的微小血管与外层门静脉之间的连续性。
肝细胞癌病变的主要引流血管可能是门静脉小分支。
