Clinical tracing of small hypovascular hepatic nodules associated with chronic liver disease

Abstract

The outcome of 45 small hepatic nodules diagnosed as hypovascular by US angiography were studied with clinical and ultrasonic follow-up carried out more than 1 years. Out of 45 nodules, 23 nodules were performed biopsy under US guidance at first detection, and hypercellularities and/or increasing in N/C ratio were observed in all 23 nodules. Enlargement of the nodule size was observed in 7 (16%) of 45 nodules, while the size has not changed in 20 (44%) nodules. Eighteen nodules (40%) become undetectable with US. Six nodules out of 7 enlarged cases developed into advanced HCCs. Four out of these malignant change group showed "vascular spot" on US angiography and/or perfusion defects on CTAP at the first detect. The remaining two cases also acquired such vascular findings at the later stage when they have enlarged. In this study, the twos of development and extension of HCCs were proved: (1) advanced HCC appear as a hypervascular spot in a benign hypovascular nodule, (2) portal perfusion in the tumor as a whole decreases and arterial vascularity increases in stead in the process of cancer development. It is concluded that, if the nodules which show "vascular spot" on US angiography and/or perfusion defect on CTAP exclude from the subject, only 5% (2/40) of the hypovascular nodules develop into advanced HCC.