Objectives: The characteristics of hypovascular and hypervascular well-differentiated hepatocellular carcinomas (HCCs) were compared in terms of tumor size, tumor markers and detectability by imaging modalities. Methods: Well-differentiated HCC nodules that are smaller than 2 cm (n = 27) were evaluated in 27 patients using histopathology and divided into 2 groups: hypovascular (n = 10) and hypervascular (n = 17). The diagnostic sensitivity of imaging modalities was then evaluated for efficiency in disclosing tumor size and tumor markers in the 2 types. Results: No difference was observed in tumor size and tumor markers between the 2 types; however, the sensitivity of contrast-enhanced CT, contrast-enhanced ultrasonography and arterioportal angiography was significantly different between the 2 types, whereas that by Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) demonstrated no difference. Conclusion: Hypovascular HCC could be diagnosed by Gd-EOB-DTPA MRI in the hepatobiliary phase.

1.
Kojiro M, Nakashima O: Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis 1999;19:287-296.
2.
Kudo M: Early hepatocellular carcinoma: definition and diagnosis. Liver Cancer 2013;2:69-72.
3.
Murakami T, Tsurusaki M: Hypervascular benign and malignant liver tumors that require differentiation from hepatocellular carcinoma: key points of imaging diagnosis. Liver Cancer 2014;3:85-96.
4.
Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, Okusaka T, Miyayama S, Tsuchiya K, Ueshima K, Hiraoka A, Ikeda M, Ogasawara S, Yamashita T, Minami T, Yamakado K; Liver Cancer Study Group of Japan: JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan. Liver Cancer 2014;3:458-468.
5.
Kudo M: Surveillance, diagnosis, treatment, and outcome of liver cancer in Japan. Liver Cancer 2015;4:39-50.
6.
Kudo M: Clinical practice guidelines for hepatocellular carcinoma differ between Japan, United States, and Europe. Liver Cancer 2015;4:85-95.
7.
Hsu C, Chen BB, Chen CH, Ho MC, Cheng JC, Kokudo N, Murakami T, Yeo W, Seong J, Jia JD, Han KH, Cheng AL: Consensus development from the 5th Asia-Pacific primary liver cancer expert meeting (APPLE 2014). Liver Cancer 2015;4:96-105.
8.
International Working Party: Terminology of nodular hepatocellular lesions. Hepatology 1995;22:983-993.
9.
International Consensus Group for Hepatocellular Neoplasia: Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 2009;49:658-664.
10.
Kudo M, Hatanaka K, Chung H, Minami Y, Maekawa K: A proposal of novel treatment-assist technique for hepatocellular carcinoma in the Sonazoid-enhanced ultrasonography: value of defect re-perfusion imaging. Kanzo 2007;48:299-301.
11.
Hayashi M, Matsui O, Ueda K, Kawamori Y, Gabata T, Kadoya M: Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology 2002;225:143-149.
12.
Tajima T, Honda H, Taguchi K, Asayama Y, Kuroiwa T, Yoshimitsu K, Irie H, Aibe H, Shimada M, Masuda K: Sequential hemodynamic change in hepatocellular carcinoma and dysplastic nodules: CT angiography and pathologic correlation. AJR Am J Roentgenol 2002;178:885-897.
13.
Kudo M, Hatanaka K, Maekawa K: Defect reperfusion imaging, a newly developed novel technology using Sonazoid in the treatment of hepatocellular carcinoma. J Med Ultrasound 2008;16:169-175.
14.
Kudo M, Hatanaka K, Maekawa K: Sonazoid-enhanced ultrasound in the diagnosis and treatment of hepatic tumors. J Med Ultrasound 2008;16:130-139.
15.
Hatanaka K, Kudo M, Minami Y, Maekawa K: Sonazoid-enhanced ultrasonography for diagnosis of hepatic malignancies: comparison with contrast-enhanced CT. Oncology 2008;75(suppl 1):42-47.
16.
Xia Y, Kudo M, Minami Y, Hatanaka K, Ueshima K, Chung H, Hagiwara S, Inoue T, Ishikawa E, Kitai S, Takahashi S, Tatsumi C, Ueda T, Hayaishi S, Maekawa K: Response evaluation of transcatheter arterial chemoembolization in hepatocellular carcinomas: the usefulness of Sonazoid-enhanced harmonic sonography. Oncology 2008;75(suppl 1):99-105.
17.
Lee JM, Yoon JH, Joo I, Woo HS: Recent advances in CT and MR imaging for evaluation of hepatocellular carcinoma. Liver Cancer 2012;1:22-40.
18.
Ricke J, Seidensticker M, Mohnike K: Noninvasive diagnosis of hepatocellular carcinoma in cirrhotic liver: current guidelines and future prospects for radiological imaging. Liver Cancer 2012;1:51-58.
19.
Ichikawa T, Sano K, Morisaka H: Diagnosis of pathologically early HCC with EOB-MRI: experiences and current consensus. Liver Cancer 2014;3:97-107.
20.
Bolondi L, Gaiani S, Celli N, Golfieri R, Grigioni WF, Leoni S, Venturi AM, Piscaglia F: Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 2005;42:27-34.
21.
Forner A, Vilana R, Ayuso C, Bianchi L, Solé M, Ayuso JR, Boix L, Sala M, Varela M, Llovet JM, Brú C, Bruix J: Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008;47:97-104.
22.
Mita K, Kim SR, Kudo M, Imoto S, Nakajima T, Ando K, Fukuda K, Matsuoka T, Maekawa Y, Hayashi Y: Diagnostic sensitivity of imaging modalities for hepatocellular carcinoma smaller than 2 cm. World J Gastroenterol 2010;16:4187-4192.
23.
Kobayashi S, Kim SR, Imoto S, Ando K, Hirakawa M, Saito J, Fukuda K, Otono Y, Sakaki M, Tsuchida S, Kim SK, Hayashi Y, Nakano M, Kudo M: Histopathological diagnosis of early HCC through biopsy: efficacy of victoria blue and cytokeratin 7 staining. Dig Dis 2012;30:574-579.
24.
Toyoda H, Kumada T, Tada T, Sone Y, Kaneoka Y, Maeda A: Tumor markers for hepatocellular carcinoma: simple and significant predictors of outcome in patients with HCC. Liver Cancer 2015;4:126-136.
25.
Hytiroglou P: Morphological changes of early human hepatocarcinogenesis. Semin Liver Dis 2004;24:65-75.
26.
Kojiro M: Pathology of Hepatocellular Carcinoma. Oxford, Blackwell Publishing, 2006.
27.
Hytiroglou P, Park YN, Krinsky G, Theise ND: Hepatic precancerous lesions and small hepatocellular carcinoma. Gastroenterol Clin North Am 2007;36:867-887.
28.
Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Yamamoto J, Shimada K, Kosuge T, Okada S, Takayasu K, Yamasaki S: Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology 1998;28:1241-1246.
29.
Nakashima O, Sugihara S, Kage M, Kojiro M: Pathomorphologic characteristics of small hepatocellular carcinoma: a special reference to small hepatocellular carcinoma with indistinct margins. Hepatology 1995;22:101-105.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.