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. 1. Introduction A stepwise model of development, from well-differentiated precursors to poorly differentiated progressed hepatocellular carcinomas (HCCs), is well established by evidences accumulated in the past three decades. In 1995 and 2009, international reproducible criteria for the diagnosis of nodular lesions of hepatocarcinogenesis were developed by the remarkable endeavors of the East and the West pathologists. At present, the criteria involve not only pathologic but also radiologic features, especially hemodynamic findings. For example, progressed HCCs are defined as radiologically hypervascular lesions without portovenous supply which histologically appear moderately or poorly differentiated; early HCCs and dysplastic nodules are defined as iso- or hypovascular lesions with portovenous supply on radiological images which appear well differentiated on histology [1, 2]. Thus, an intimate knowledge of the relations between tumor hemodynamics and hepatocarcinogenesis would be useful for the management of carcinogenic nodules as well as for the better understanding of multistep models of hepatocarcinogenesis. This review focuses on radiologic hemodynamic features of carcinogenic hepatocyte nodules arising from cirrhotic livers, that is, dysplastic nodules, early HCCs, and progressed HCCs, paying close attention to radio-pathological correlations and outcomes of
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