Imaging of multistep human hepatocarcinogenesis by CT during intra-arterial contrast injection

Various types of hepatocellular nodules are seen in cirrhotic livers. In these nodules, two types of human hepatocarcinogenesis are now considered. One is de novo hepatocarcinogenesis and the other is the stepwise development from high-grade dysplastic nodule (DN), high-grade DN with well-differentiated HCC foci, and overt HCC. According to our analysis by CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) and histological study, in accordance with the elevation of the grade of malignancy of the nodules, the portal tract including normal portal vein (intranodular portal supply) and hepatic artery (intranodular arterial supply through normal hepatic arteries) are decreased. On the other hand, abnormal artery (intranodular arterial supply through newly formed abnormal arteries) gradually increases. Therefore, we can estimate the grade of malignacy of the nodules from intranodular blood supply. To know this blood supply pattern is important for the early detection, characterization and treatment of early stage HCCs. We also revealed that there was a close correlation between the prognosis of the nodules and the blood supply patterns.