Detection and Characterization of Hepatocellular Carcinoma by Imaging Osamu Matsui  Clinical Gastroenterology and Hepatology  Volume 3, Pages S136-S140 (October 2005) DOI: 10.1016/S1542-3565(05)00707-X Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 Screening protocol for HCC in Japan. AFP, alpha-fetoprotein; PIVKA, protein induced by vitamin K absence or antagonism. Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 A minute, moderately differentiated HCC detected by periodic CT examination. (A) Arterial dominant phase of dynamic CT revealed a minute, enhanced nodule (center, arrow). Left, precontrast CT; right, postcontrast CT. (B) Resected specimen demonstrated a moderately differentiated HCC around 1 cm in diameter (arrow). Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 Early HCC (highly well-differentiated HCC) with fatty metamorphosis. (A) Hematoxylin-eosin stain; original magnification 1× (arrows indicate the lesion). (B) Hematoxylin-eosin stain; original magnification 200×. Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 4 High-grade DN with malignant subfocus (one type of early HCC). (A) A tiny hypervascular focus in entirely isodense nodule is shown on CTHA (right, arrow), indicating partially increased arterial supply (group III), and definitely hypodense focus in slightly hypodense nodule on CTAP (left, arrow), indicating partially absent intranodular portal supply (group C). (B) Surgical resection revealed high-grade DN with a malignant subfocus (HCC, well-differentiated HCC; HDN, high-grade DN). Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 5 High-grade DN. CTHA (right, arrow) shows hypodensity relative to the surrounding liver, indicating decreased intranodular arterial supply (group II). CTAP shows isodensity, indicating almost the same intranodular portal supply (left, arrow) (group A). Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 6 Early HCC (highly well-differentiated HCC). CTHA (right, arrow) shows isodensity relative to the surrounding liver, indicating almost the same intranodular arterial supply (group I). CTAP shows slight hypodensity, indicating almost the same intranodular portal supply (right, arrow) (group B). Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 7 Moderately differentiated HCC (classic HCC). CTHA (right, arrow) shows definite hyperdensity, indicating markedly increased intranodular arterial supply (group IV). CTAP shows definite hypodensity, indicating absent intranodular portal supply (left, arrow) (group D). Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 8 Diagram of the stepwise changes of the intranodular blood supply during human hepatocarcinogenesis. LRN, large regenerative nodule; LDN, low-grade DN; HDN, high-grade DN; e-HCC, early HCC; wd-HCC, well-differentiated HCC. Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 9 Dynamic CT in high-grade DN with a malignant subfocus. On portal phase of dynamic CT, the entire tumor is shown as hypodense nodule (right, arrow). On arterial dominant phase, a tiny enhanced focus is demonstrated in the nodule (middle, arrow). On precontrast CT, this nodule is seen as a faintly hypodense nodule (left, arrow). (The same case as shown in Figure 4.) Clinical Gastroenterology and Hepatology 2005 3, S136-S140DOI: (10.1016/S1542-3565(05)00707-X) Copyright © 2005 American Gastroenterological Association Terms and Conditions