We performed serial hemodynamics in 15 patients with 21 well-different
iated hepatocellular carcinomas. The total length of the observation p
eriod ranged from 129 to 678 days (median, 368). We investigated both
arterial and portal blood how at intervals of at least 4 months. Arter
ial blood how was measured with carbon dioxide-enhanced ultrasonograph
y (US), and portal blood flow was measured with computed tomographic a
rterial portography (CTAP), None of the tumors were hypervascular on t
he initial study; however, by the final study nine nodules (42.9%) had
become homogeneously hypervascular, two (9.5%) had become partially h
ypervascular, and the others did not change. Of 10 nodules without por
tal blood supply on any study, 8 became hypervascular by the final stu
dy. Of 11 nodules with portal blood supply on the initial study, a fol
low-up study showed no change in portal flow in 6 and the loss of port
al how in 5. Four of these five became hypervascular, with a documente
d loss of portal flow before the increase in arterial flow. The doubli
ng time of tumors with a homogeneous increase in arterial blood flow r
anged from 89 to 333 days (median, 172), whereas the doubling time of
other tumors ranged from 227 to 607 days (median, 392). Thus, growth r
ate and vascularity in well-differentiated hepatocellular carcinoma ar
e closely correlated. When the well-differentiated hepatocellular carc
inoma has portal blood flow and is not hypervascular, it grows slowly,
On the other hand, when it loses portal blood flow and becomes hyperv
ascular, it grows rapidly.