Three-dimensional image analysis of the hepatic restructuring process in chronic active hepatitis

OBJECTIVE: To elucidate the process of hepatic restructuring in the course of chronic hepatitis from a morphologic viewpoint. STUDY DESIGN: The three-dimensional (3-D) liver structure was investigated by computer-aided reconstruction in five cases (one autopsy and four surgic al cases) of chronic active hepatitis (type C), including early to late sta ges of restructuring. RESULTS: Our 3-D reconstruction revealed the following. At an early stage, portal and periportal inflammation and fibrosis widened the portal tracts, giving rise to the formation of portal-to-portal and portal-to-hepatic veno us connections, although most central veins were still located at an almost normal site in the hepatic lobules. In a middle stage, bridging fibrosis d eveloped to create a network of interstitium where the central veins were r ather decreased in number, with regenerative nodules multiplying in the par enchyma. At the late stage, the lobular structure was destroyed, and the pa renchyma consisted uniformly of regenerative nodules, with remaining but re arranged lobules among them. CONCLUSION: The above changes of liver structure suggest that in cirrhogene sis from chronic hepatitis, a combination of nodular regeneration and forma tion of an interstitial network come to replace the normal lobular structur e, hastening the development of liver cirrhosis.