Correlation between the blood supply and grade of malignancy of hepatocellular modules associated with liver cirrhosis: Evaluation by CT during intraarterial injection of contrast medium

OBJECTIVE. The purpose of this study is to evaluate the correlation between the intranodular blood supply revealed by CT during intraarterial injectio n of contrast medium, mainly using helical CT, and the grade of malignancy of hepatocellular nodules associated with liver cirrhosis as classified by the International Working Party of the World Congress of Gastroenterology. SUBJECTS AND METHODS. We studied 201 histologically proven nodules (101 res ected and 100 biopsied nodules), including 47 low-grade dysplastic nodules (low-DNs), 56 high-grade dysplastic nodules (high-DNs), 24 well-differentia ted hepatocellular carcinomas (wd-HCCs), and 74 moderately or poorly differ entiated HCCs (mp-HCCs), in 139 cirrhotic patients. Findings on CT during a rterial portography (n = 201) and CT during hepatic arteriography (n = 74) were reviewed and compared with the histologic diagnosis. RESULTS. CT findings were classified into four types relative to the surrou nding liver: type A (isodense), type B (slightly hypodense), type C (partia lly hypodense), and type D (markedly hypodense) on CT during arterial porto graphy and type I (isodense), type II (hypodense), type III (partially hype rdense), and type IV (hyperdense) on CT during hepatic arteriography. On CT during arterial portography, the distributions of each type were low-DN (n = 47 [A, n = 36; B, n = 8; C, n = 3]), high-DN (n = 56 [A, n = 18; B, n = 20; C, n = 10; D, n = 8]), wd-HCC (n = 24; [B, n = 4; C, n = 13; D, n = 7]) , and mp-HCC (n = 74 [D, n = 74]). On CT during hepatic arteriography, the distributions were low-DN (n = 26 [I, n = 18; II, n = 7; III, n = 1]), high -DN (n = 19 [I, n = 6; II, n = 7; III, n = 4; IV, n = 2]), wd-HCC (n = 15 [ I, n = 1; III, n = 8, IV, n = 6]), and mp-HCC (n = 14 [IV, n = 14]) we foun d a statistically significant correlation between the four types and the gr ade of malignancy of these nodules. CONCLUSION. Findings on CT during arterial portography and CT during hepati c arteriography correlated positively with histologic grading when overlap in appearance between dysplastic nodules and HCCs occurred. The concept rev ealed in this study can apply to diagnoses made on the basis of Doppler son ography, dynamic CT, and MR imaging.