• HCC
• RNA sequence
• dog
• liver
• radiogenomics

• 22K05991 JSPS KAKENHI

• Hepatectomy
• Perihepatic packing
• Rupture hepatocellular carcinoma
• Transarterial embolization

• Humans
• Liver Neoplasms/therapy
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Male
• Female
• Retrospective Studies
• Middle Aged
• Embolization, Therapeutic/methods
• Aged
• Rupture, Spontaneous
• Hepatectomy
• Prognosis
• Survival Rate
• Treatment Outcome

• blood supply
• computed tomography
• hepatectomy
• hepatocellular carcinoma
• recurrence
• survival

• Abdomen
• Dual-energy CT
• Iodine map
• Quantitative imaging
• Virtual unenhanced image

To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis.

HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models.

Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict “Improved” outcome, and 4 AEF texture features were applied into modeling to predict “Un-worsened” outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively.

Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.

• AEF
• HCC
• Heterogeneity
• TACE
• Texture analysis
• Tumor response

Careful selection of hepatocellular carcinoma (HCC) patients prior to chemoembolization treatment is a daily reality, and is even more necessary with new available therapeutic options in HCC.

To propose two new models to better stratify patients and maximize clinical benefit: “6 and 12” and “pre/post-TACE-predict” (TACE, transarterial chemoembolization).

We evaluated and compared their performance in predicting overall survival with other systems {Barcelona Clinic Liver Cancer (BCLC), Albumin-Bilirubin (ALBI) and NIACE [Number of tumor(s), Infiltrative HCC, alpha-fetoprotein, Child-Pugh (CP), and performance status]} in two HCC French cohorts of different stages enrolled between 2010 and 2018.

The cohorts included 324 patients classified as BCLC stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2). The majority of the patients had cirrhosis with preserved liver function. “Pre-TACE-predict” and “6 and 12” models identified three distinct categories of patients exhibiting different prognosis in cohort 1. However, their prognostic value was no better than the BCLC system or NIACE score. Liver function based on CP and ALBI grades significantly impacted patient survival. Conversely, the “post-TACE-predict” model had a higher predictive value than other models. The stratification ability as well as predictive performance of these new models in an intermediate/advanced stage population was less efficient (cohort 2).

The newly proposed “Pre-TACE-predict” and “6 and 12” models offer an interesting stratification into three categories in a recommended TACE population, as they identify poor candidates, those with partial control and durable response. The models' contribution was reduced in a population with advanced stage HCCs.

• Hepatocellular carcinoma
• Transarterial chemoembolization
• Pre-TACE-predict
• Six-and-twelve
• Barcelona Clinic Liver Cancer
• Prognosis

• ct perfusion
• hepatocellular carcinoma
• histological grade
• tri-phasic ct
• tumor attenuation

• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/blood supply
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Female
• Hepatic Artery/pathology
• Humans
• Liver/blood supply
• Liver/pathology
• Liver Neoplasms/blood supply
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Male
• Middle Aged
• Neoplasm Grading/methods
• Observer Variation
• Perfusion
• Perfusion Imaging/methods
• Portal Vein/pathology
• Predictive Value of Tests
• ROC Curve
• Statistics, Nonparametric
• Tomography, X-Ray Computed/methods

• hepatocellular carcinoma
• perfusion
• computed tomography
• histological grade
• histogram

• Carcinoma, Hepatocellular/diagnostic imaging
• Contrast Media
• Humans
• Liver Neoplasms/diagnostic imaging
• Perfusion
• Retrospective Studies
• Sensitivity and Specificity
• Tomography, X-Ray Computed

• diffusion magnetic resonance imaging
• hepatocellular carcinoma
• liver cirrhosis
• magnetic resonance imaging

• Adult
• Aged
• Carcinoma, Hepatocellular/blood supply
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Diagnosis, Differential
• Diffusion Magnetic Resonance Imaging/methods
• Female
• Humans
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/pathology
• Liver Neoplasms/blood supply
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged

Purpose: This study aims to explore the imaging–clinic relationship and an optional imaging biomarker of hepatocellular carcinoma (HCC) by using texture analysis on arterial enhancement fraction (AEF).

Materials and Methods: The HCC patients treated in No. 2 Interventional Ward, ShengJing Hospital of China Medical University from June 2018 to June 2019 were enrolled, for whom tri-phasic enhanced CT scans were acquired. Perfusion analysis and texture analysis were then performed on the tri-phasic enhanced CT images. After the region of interest (ROI) of viable HCC was drawn, 13 AEF textures describing the values distribution were conducted. A between-groups comparison of AEF textures was made where the cases had grouping properties, a correlation analysis was made between AEF textures and alpha-fetoprotein (AFP) as well as other clinical data which were digital, and regression analysis was made when a significant correlation was found. SPSS 19.0 (IBM) was utilized for statistical analysis; a significant difference was considered when P < 0.05.

Results: Twenty-five HCC patients were enrolled. Several AEF textures were found to have a correlation with clinical features, including previous surgery history, age, glutamic oxaloacetylase, indirect bilirubin, creatinine, and AFP. The majority of AEF textures (up to 9/13) were found to have a correlation with AFP (SD, variance, uniformity, energy, entropy, inertia, correlation, inverse difference moment, and cluster prominence), while six or seven textures have a linear or cubic relationship with AFP (SD, variance, uniformity, inertia, correlation, cluster prominence, plus inverse difference moment).

Conclusion: The AEF textures of HCC are strongly correlated with and are impacted by AFP, which may enable AEF to act as an optional imaging biomarker of HCC.

• AEF
• AFP
• HCC
• angiogenesis
• heterogeneity
• texture

Intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI) and dynamic contrast‐enhanced MRI (DCE‐MRI) are sensitive imaging modalities for detecting liver lesions, but their value in evaluating cirrhosis‐related nodules remains unclear.

To investigate whether IVIM‐DWI and DCE‐MRI can differentiate different types of cirrhosis‐related nodules, and whether these modalities can monitor changes in cell density and angiogenesis during the malignant transformation of cirrhosis‐related nodules in a rat model

Prospective.

Thirty‐five male Sprague–Dawley rats with 106 cirrhosis‐related nodules (19 regenerative nodules [RNs], 47 dysplastic nodules [DNs], and 40 hepatocellular carcinomas [HCCs]).

IVIM‐DWI and DCE sequence at 3.0T MRI.

IVIM‐DWI parameters (D, D*, f, and apparent diffusion coefficient [ADC]) and DCE‐MRI parameters (K^trans, K_ep, and V_e) were calculated by two radiologists using postprocessing software. The “cell density” and “unpaired arterial ratio” were analyzed with a microscope by two pathologists.

MRI parameters were compared among the different types of nodules by one‐way analysis of variance or the Kruskal–Wallis test. The Pearson correlation test was used to analyze the correlation of MRI parameters with the pathological types of nodules, cell density, and unpaired arterial ratio.

The K^trans, K_ep, and V_e values of HCCs were significantly higher than those of DNs and RNs. D and ADC values were significantly lower in HCCs than in DNs and RNs. There were moderate positive correlations of K^trans with the pathological types of nodules and the unpaired arterial ratio. Moderate negative correlations were observed among D, ADC, and the pathological types of nodules, between D and cell density, and between ADC and cell density.

IVIM‐DWI and DCE‐MRI are valuable in differentiating different types of cirrhotic‐related nodules. D and ADC are correlated with changes in cell density during the malignant transformation of cirrhosis‐related nodules, while K^trans is correlated with increased angiogenesis.

Level of Evidence: 1

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2020;51:812–823.

• cirrhosis-related nodules
• dynamic contrast-enhanced MRI
• intravoxel incoherent motion DWI

• APASL
• Asia–Pacific
• Hepatocellular carcinoma
• Treatment algorithm

• Asia
• Carcinoma, Hepatocellular/epidemiology
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/virology
• Coinfection/epidemiology
• Disease Management
• Evidence-Based Medicine
• Hepatitis B/epidemiology
• Hepatitis B/therapy
• Hepatitis C/epidemiology
• Hepatitis C/therapy
• Humans
• Liver Neoplasms/epidemiology
• Liver Neoplasms/therapy
• Liver Neoplasms/virology
• Meta-Analysis as Topic
• Practice Guidelines as Topic

MRI and perfusion-CT (PCT) are both useful imaging techniques for detection and characterization of liver lesions. The aim of this study was to compare the diagnostic accuracy of imaging parameters derived from PCT and gadoxetic acid-enhanced MRI in patients with hepatocellular carcinoma (HCC).

36 patients with liver cirrhosis and a total of 67 lesions referred to our hospital for multi-parametric diagnosis of HCC-suspected liver lesions in the setting of liver cirrhosis were prospectively enrolled and underwent PCT and MRI. HCC diagnosis was confirmed either by histology (n = 60) or interval growth (n = 7). For PCT, mean/max blood flow (BF), blood volume (BV), k-trans, arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI) were quantified. Two readers identified the lesions based on single maps each being blinded to the number of lesions.

MRI-protocol included fat-suppressed T1w-VIBE sequences obtained before, 2, 5, 10 and 20 min after the injection of gadoxetic acid as well as non-enhanced coronal HASTE, axial T1w-VIBE, fat-suppressed T2w-TSE and DWI. Quantitative analysis was performed using enhancement ratios between tumor and liver parenchyma for post-contrast in the hepatobiliary phase (RIR_HB), arterial (ER_a) and late-venous (ER_v) phases as well as signal intensity ratios (liver/parenchyma) on T1w (RIR_T1) and T2w (RIR_T2).

In PCT analysis, all lesions exhibited high BF_max values (63–250 mL/100 g tissue) and were visible on HPI maps with high degrees of arterial blood supply of (HPI > 96%).

In MRI, RIR_HB was negative in 8/67. 12/67 HCCs were missed on DWI. 46/67 HCCs showed wash-in and 47/67 HCC showed wash-out of contrast agent. 6/67 HCCs were missed on T1w and 11/67 were missed on T2w-sequences when analyzed separately, while analysis of multiparametric MRI combining typical enhancement pattern, visibility on hepatobiliary phase and T1w-images the same number of lesions as PCT irrespective of their size (1–19 cm) were detected. Quantification of early enhancement by ER_a or ER_v did not improve detection rates.

Perfusion-CT and gadoxetic acid-enhanced MRI were comparable in detecting HCC lesions. For PCT a mean HPI > 96% proved to be a very robust parameter for detection and characterization of HCC.

• Hepatocellular Carcinoma
• MRI
• contrast agent
• perfusion
• perfusion-CT

Quantitative dynamic contrast enhanced MRI (DCE-MRI) can offer information related to tumour perfusion and permeability (K^trans), rate constant (K_ep), extravascular extracellular volume fraction (V_e) and distribution volume (V_d). Different types of gadolinium-based contrast agents (GBCAs) may traverse the vascular wall with different velocities owing to their physicochemical characteristics. The purpose of this article was to compare the DCE-MRI quantitative results (K^trans, K_ep, V_e and V_d) between Magnevist and Eovist in a VX2 rabbit liver tumour model. Sixteen rabbits (body weight, 3 Kg; random gender) containing implanted hepatic VX2 carcinomas were randomly divided into two groups based on the regimen of MRI contrast agent administered, eight rabbits in each group. All rabbits underwent a liver DCE-MRscan before tumour transplantation. Fourteen days after tumour transplantation, the eight rabbits in Group A (Magnevist group) underwent a liver DCE-MR scan in a 3.0 T Magnetom Verio MR scanner (Siemens Healthcare, AD, Germany) after the administration of Magnevist at the flow rate of 1 ml s^–1. The Group B rabbits underwent the same scan except for the administration of Eovist at the same flow rate. Twenty-four hours after the initial DCE-MRI, repeat DCE-MRI was performed with the cross-over GBCA at the same flow rate in each group. Every rabbit received 0.6 ml GBCA (0.2 ml Kg^–1) during each DCE-MRI. K^trans, K_ep, V_e and V_d were measured in the tumour lesion and compared with normal liver tissue in the same slice. A pathologic examination was also performed. Hepatocellular carcinoma was diagnosed in all 16 rabbits by pathologic examination. There were no significant differences in K^trans, V_e, K_ep and V_d between the two groups of rabbits (p > 0.05). The K^trans, V_e, K_ep and V_d of the VX2 rabbit liver tumour model were significantly higher than the normal liver parenchyma (0.742 ± 0.086 vs 0.027 ± 0.002, 7.345 ± 0.043 vs 6.721 ± 0.035, 0.101 ± 0.005 vs 0.101 ± 0.005, 0.419 ± 0.083 vs 0.037 ± 0.005, respectively; p < 0.01). The K^trans, V_e and V_d of Eovist group were significantly higher compared with the values in the Magnevist group (0.116 ± 0.016 vs 0.010 ± 0.002, respectively, p < 0.01; 0.101 ± 0.005 vs 0.004 ± 0.0009, respectively, p < 0.01; 0.419 ± 0.083 vs 0.037 ± 0.005, respectively, p < 0.001). There was no significant difference in K_ep between the Eovist and Magnevist groups (7.345 ± 0.043 vs 6.721 ± 0.035, respectively; p > 0.05). In the VX2 rabbit liver tumour model, DCE-MRI performed with different types of GBCA can develop different quantitative results with respect to K^trans, V_e and V_d. The liver-specific GBCA, Eovist, is more sensitive than the general GBCA, Magnevist, in detecting tumour perfusion and permeability.

• Elasticity imaging techniques
• Hepatocellular carcinoma
• Perfusion imaging

• Aged
• Aged, 80 and over
• Blood Volume
• Carcinoma, Hepatocellular/diagnostic imaging
• Cone-Beam Computed Tomography/methods
• Elasticity/physiology
• Elasticity Imaging Techniques/methods
• Female
• Humans
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/pathology
• Liver Neoplasms/diagnostic imaging
• Male
• Middle Aged
• Neovascularization, Pathologic/diagnostic imaging
• Ultrasonography

• Anatomical resection
• Cirrhosis
• Curative
• Hepatocellular carcinoma
• Prognosis

• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Disease-Free Survival
• Hepatectomy
• Humans
• Liver/pathology
• Liver/surgery
• Liver Cirrhosis/pathology
• Liver Cirrhosis/surgery
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Neoplasm Recurrence, Local/pathology
• Perioperative Period
• Postoperative Period
• Prognosis
• Surgical Procedures, Operative
• Treatment Outcome
• Ultrasonography

• Aged
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/diagnostic imaging
• Contrast Media
• Diagnosis, Differential
• Female
• Humans
• Iodine
• Liver Neoplasms/complications
• Liver Neoplasms/diagnostic imaging
• Male
• Middle Aged
• Multidetector Computed Tomography/methods
• Portal Vein/diagnostic imaging
• Radiographic Image Enhancement/methods
• Radiography, Dual-Energy Scanned Projection/methods
• Reproducibility of Results
• Sensitivity and Specificity
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/etiology

• Angiogenesis
• Dynamic contrast -enhanced -MRI (DCE-MRI)
• Hepatocellular carcinoma
• Hepatocellular nodules in cirrhosis
• Ktrans

AIM: To find out if magnetic resonance (MR)-signal characteristics of hepatocellular carcinomas (HCC) correlate with perfusion parameters assessed by volume perfusion computed tomography (VPCT).

METHODS: From October 2009 to January 2014, 26 (mean age, 69.3 years) patients with 36 HCC lesions who underwent both VPCT and MR liver imaging were analysed. We compared signal intensity in the T1w- and T2w-images and wash-in/wash-out kinetics on post-contrast MR images with mean values of blood flow (BF, mL/100 mL per minute), blood volume (BV, mL/100 mL), k-trans (mL/100 mL per minute), arterial liver perfusion (mL/100 mL per minute), portal venous perfusion and hepatic perfusion index (HPI, %) obtained by VPCT. Signal intensity on magnetic resonance imaging (MRI) was classified hyper/iso/hypointense compared with surrounding liver parenchyma.

RESULTS: Signal intensity on native T1w- and T2w-images was hyper/iso/hypo in 4/16/16 and 21/14/1 lesions, respectively. Wash-in and wash-out contrast kinetics were found on MRI in 33 of 36 lesions (91.7%) and 25 of 36 lesions (69.4%), respectively. The latter was observed significantly more often in higher graded lesions (P < 0.005). HPI was 94.7% ± 6.5%. There was no significant relationship between lesion’s MR-signal intensity, MR signal combinations, size and any of the VPCT-perfusion parameters. However HPI was constantly high in all HCC lesions.

CONCLUSION: VPCT parameters add limited value to MR-lesion characterization. However in HCC lesions with atypical MR signal characteristics HPI can add a parameter to ensure HCC diagnosis.

• Hepatocellular carcinoma
• Volume perfusion computed tomography
• Magnetic resonance imaging

• Sonazoid
• hepatocellular carcinoma
• ultrasonography

• Hepatocellular carcinoma (HCC)
• arterial blood supply
• sorafenib

• dysplastic nodule
• gadoxetate disodium
• hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide. Imaging plays a critical role in HCC screening and diagnosis. Initial screening of patients at risk for HCC is performed with ultrasound. Confirmation of HCC can then be obtained by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), due to the relatively high specificity of both techniques. This article will focus on reviewing MRI techniques for imaging HCC, felt by many to be the exam of choice for HCC diagnosis. MRI relies heavily upon the use of gadolinium-based contrast agents and while primarily extracellular gadolinium-based contrast agents are used, there is an emerging role of hepatobiliary contrast agents in HCC imaging. The use of other non-contrast enhanced MRI techniques for assessing HCC will also be discussed and these MRI strategies will be reviewed in the context of the pathophysiology of HCC to help understand the MR imaging appearance of HCC.

• HCC
• Hepatocellular carcinoma
• MRI
• Magnetic Resonance Imaging
• liver

• dysplastic nodule
• hepatocarcinogenesis
• hepatocellular carcinoma
• imaging diagnosis
• liver neoplasms

• Animals
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Lewis Lung/diagnostic imaging
• Cell Line, Tumor
• Contrast Media/pharmacokinetics
• Humans
• Liver/blood supply
• Liver/diagnostic imaging
• Liver Neoplasms/diagnostic imaging
• Mice
• Mice, Inbred C57BL
• Portography/methods

• Hepatocellular carcinoma
• Pharmacokinetic
• Tumor characterization
• Volume perfusion CT (VPCT)

• cellular differentiation
• contrast media
• contrast-enhanced sonography
• gastrointestinal ultrasound
• hepatocellular carcinoma
• perfluorobutane

• Adult
• Aged
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/diagnostic imaging
• Contrast Media/administration & dosage
• Diagnosis, Differential
• End Stage Liver Disease/diagnostic imaging
• End Stage Liver Disease/etiology
• Female
• Ferric Compounds/administration & dosage
• Hepatic Artery/diagnostic imaging
• Humans
• Image Enhancement/methods
• Iron/administration & dosage
• Kupffer Cells/diagnostic imaging
• Liver Neoplasms/complications
• Liver Neoplasms/diagnostic imaging
• Male
• Middle Aged
• Oxides/administration & dosage
• Reproducibility of Results
• Sensitivity and Specificity
• Ultrasonography/methods

Transarterial chemoembolization (TACE) using iodized oil (Lipiodol^®) (Lp-TACE) as a carrier of chemotherapeutic agents has been routinely performed to control hepatocellular carcinomas (HCC) in Japan, and its use has yielded fairly beneficial therapeutic results. Lipiodol is thought to pass through the tumor sinusoids of HCC and reach the outflow drainage areas, namely, the portal venous side of the tumor. By doing this, Lipiodol blocks not only the tumor’s arterial inflow but also its portal venous outflow, providing sufficient ischemic effects. It is known that the inflow blood system, tumor sinusoids, and outflow blood system change drastically during the process of multistep hepatocarcinogenesis; thus, it is reasonable to postulate that the distribution of Lipiodol and the subsequent therapeutic effect of Lp-TACE may also change during that process. Arterial inflow to HCC is highest for moderately differentiated HCC (mHCC) and is relatively low in well or poorly differentiated HCC (wHCC and pHCC, respectively). It has been suggested that the metabolic state of wHCC and mHCC is aerobic, while that of pHCC is anaerobic. The tumor sinusoids in wHCC and mHCC are small in size and large in number, while those in pHCC are large in size and small in number. This finding results in a greater chance of tumor cell exposure to chemotherapeutic agents in the former and a lesser chance in the latter. The outflow tract, namely, the drainage system via the residual portal venous branches within the pseudocapsule, is more complete in mHCC and pHCC and less so in wHCC. Considering all of these components of HCC of different histological grades, Lp-TACE should have the greatest effect on mHCC and a relatively low effect on wHCC and pHCC. To achieve consistently high therapeutic results, it is important to consider these components, which affect the sensitivity of HCC to Lp-TACE, to maximize both the chemotherapeutic and ischemic effects of this therapy.

• embolotherapy Lipiodol
• histological grade
• liver cancer
• multistep carcinogenesis

• Carcinoma, Hepatocellular/etiology
• Carcinoma, Hepatocellular/pathology
• Humans
• Image Enhancement/methods
• Liver Cirrhosis/complications
• Liver Cirrhosis/pathology
• Liver Neoplasms/etiology
• Liver Neoplasms/pathology
• Magnetic Resonance Angiography/methods
• Neovascularization, Pathologic/etiology
• Neovascularization, Pathologic/pathology
• Precancerous Conditions/pathology
• Reproducibility of Results
• Sensitivity and Specificity

• DCE-MRI
• hepatic perfusion modeling
• hepatocellular carcinoma
• quantitative perfusion MRI
• tumor perfusion modeling

• Adult
• Aged
• Blood Flow Velocity
• Breath Holding
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/physiopathology
• Computer Simulation
• Diagnosis, Differential
• Feasibility Studies
• Female
• Humans
• Image Enhancement/methods
• Image Interpretation, Computer-Assisted/methods
• Liver Circulation
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/physiopathology
• Liver Neoplasms/diagnosis
• Liver Neoplasms/physiopathology
• Magnetic Resonance Angiography/methods
• Male
• Middle Aged
• Models, Biological
• Reproducibility of Results
• Sensitivity and Specificity
• Young Adult

• R01 CA116380 NCI NIH HHS
• R01 DK088925 NIDDK NIH HHS
• R01 DK083380 NIDDK NIH HHS
• T32 CA009206 NCI NIH HHS
• T32 GM008692 NIGMS NIH HHS
• RC1 EB010384 NIBIB NIH HHS
• R01 DK096169 NIDDK NIH HHS

Tumor hemodynamics of carcinogenic hepatocytes nodules, that is, low grade dysplastic nodules, high grade dysplastic nodules, early hepatocellular carcinomas (HCCs), and progressed HCCs, change during multistep dedifferentiation of the nodules. Morphometric analyses of inflow vessels of these nodules indicate that the portal veins of carcinogenic hepatocyte nodules monotonically decrease whereas the arteries bitonically change, first decrease and then increase. Findings on imaging techniques depicting these changes in tumor blood inflows, especially intra-arterial contrast-enhanced computed tomography, closely related not only to the histological differentiation of the nodules but also to the outcomes of the nodules. Histological analyses of connections between the vessels within the tumors and those in the surrounding livers and findings on imaging techniques indicate that drainage vessels of HCC change from hepatic veins to hepatic sinusoids and then to portal veins during multistep hepatocarcinogenesis. Understanding of tumor hemodynamics through radio-pathological correlations will be helpful in drawing up therapeutic strategies for carcinogenic hepatocyte nodules arising in cirrhosis.

• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/pathology
• Contrast Media
• Diagnosis, Differential
• Female
• Gadolinium DTPA
• Humans
• Image Interpretation, Computer-Assisted
• Liver Neoplasms/diagnosis
• Liver Neoplasms/pathology
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Precancerous Conditions/diagnosis
• Precancerous Conditions/pathology
• Retrospective Studies

• Adult
• Aged
• Blood Circulation
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/physiopathology
• Endpoint Determination
• Female
• Fluorodeoxyglucose F18
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/physiopathology
• Male
• Middle Aged
• Neovascularization, Pathologic/diagnostic imaging
• Positron-Emission Tomography
• Time Factors
• Whole Body Imaging

Curative therapies for hepatocellular carcinoma (HCC), such as resection and liver transplantation, can only be applied in selected patients with early tumors. More advanced stages require local or systemic therapies. Resection of HCC offers the only hope for cure. Even in patients undergoing resection, recurrences are common. Chemoembolization, a technique combining intra-arterial chemotherapy with selective tumor ischemia, has been shown by randomized controlled trials to be efficacious in the palliative setting. There is now renewed interest in transarterial embolization/transarterial chemoembolization (TACE) with regards to its use as a palliative tool in a combined modality approach, as a neoadjuvant therapy, in bridging therapy before transplantation, for symptomatic indications, and even as an alternative to resection. There have also been rapid advances in the agents being embolized trans-arterially (genes, biological response modifiers, etc.). The current review provides an evidence-based overview of the past, present and future trends of TACE in patients with HCC.

• Liver tumors
• Embolization
• Chemoembolization
• Review