Arterial blood supply of hepatocellular carcinoma and histologic grading: radiologic-pathologic correlation

The objective of our study was to clarify the sequential changes of arterial blood supply during the development of hepatocellular carcinoma (HCC) with an emphasis on its late stage.

Sixty HCC nodules were confirmed at pathology in 59 patients who had undergone CT hepatic arteriography and CT during arterioportography (CTAP). Lesions were classified into one of the four groups: group 1, nodules that appeared to show preserved portal perfusion on CTAP and showed hypo- or isoattenuation on CT hepatic arteriography; group 2, very hyperattenuating on CT hepatic arteriography; group 3, hyperattenuating on CT hepatic arteriography; and group 4, hypo- or isoattenuating on CT hepatic arteriography. Groups 2, 3, and 4 showed the portal perfusion defect on CTAP. These hemodynamic patterns were compared among different histologic grades. We also examined the number of unpaired arteries and the Ki-67 labeling index of the tumor pathologically.

The numbers of lesions in each group were as follows for groups 1, 2, 3, and 4, respectively: 17, one, two, and 0 well-differentiated HCCs; 0, 10, nine, and one moderately differentiated HCC; and 0, three, 12, and five poorly differentiated HCCs. The lesions showed significantly different hemodynamic patterns among different histologic grades (Cramer's V = 0.6919, p < 0.0001). The number of unpaired arteries showed a strong correlation with Ki-67 labeling index in well-differentiated HCC and moderately differentiated HCC (rho = 0.673, p < 0.0001) and a moderate inverse correlation with Ki-67 labeling index in poorly differentiated HCC (rho = -0.540, p = 0.0185).

In the late stage of HCC development, the arterial blood supply significantly decreases as the histologic grade progresses.