IMMAGINI Fig 1-Pattern A

Nella fase arteriosa è possibile apprezzare la iperintensità della nodularità del IV segmento, che risulta isointensa in fase di acquisizione dinamica tardiva. Nella fase epatobiliare, la nodularità non risulta chiaramente apprezzabile. L’analisi istologica ha posto diagnosi di nodulo displasico di basso grado.

Fig. 2-Pattern B

Nella fase arteriosa è possibile apprezzare la iso/ipointensità della nodularità del IV segmento, che risulta ipointensa in fase di acquisizione dinamica tardiva. Nella fase epatobiliare, la nodularità appare più evidente e risulta ipointensa. L’analisi istologica ha posto diagnosi di nodulo displasico di alto grado.

Venosa Epatobiliare

Arteriosa

Venosa Epatobiliare

44

Fig. 3-Pattern C

Nella fase arteriosa è possibile apprezzare la ipervascolarizzazione della nodularità del IV segmento, che risulta ipointensa in fase di acquisizione dinamica tardiva. Nella fase epatobiliare tale nodularità risulta ipointensa. L’analisi istologica ha posto diagnosi di HCC.

Fig. 4-Pattern D

Nella fase arteriosa è possibile apprezzare l’ iperintensità di segnale della nodularità dell’VIII segmento, che risulta essere isointensa nella fase tardiva. Nella fase epatobiliare tale nodularità risulta isointensa rispetto al circostante parenchima. L’analisi istologica ha posto diagnosi di displasia di basso grado.

Venosa Epatobiliare

Arteriosa

Venosa Epatobiliare

45

BIBLIOGRAFIA

1) Llovet JM, Bruix J (2003) Sistematic review of randomized trials for unresectable hepatocellular carcinoma: Chemioembolization improves survival. Hepatology 37(2):429-442 2) Bruix J, Scherman M, et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European association for the study of the liver. J Hepatol 35(3):421

3) Bosh X.,Ribes J., Borras J.: Epidemiology of primary liver cancer. Seminars in Liver Desease 1999; 19: 271-286

4) Kojiro M. Diagnostic discrepancy of early hepatocellular carcinoma between Japan and West. Hepatology Res 2007;37:S249-S252

5) International Working Party. Terminology of nodular hepatocellular lesions. HEPATOLOGY 1995;22:983-993

6) Pathologic Diagnosis of Early Hepatocellular Carcinoma: A Report of the International Consensus Group for Hepatocellular Neoplasia HEPATOLOGY, Vol. 49, No. 2, 2009

7) Befeler AS, Di Bisceglie AM.et al (2002) Hepatocellular carcinoma: diagnosis and treatment. Gastroenterology ;122:1609-1619

8) Bolondi L, Gaiani S, Celli N, et al. (2005) Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology ;42(1):27-34

9) Sherman M, Peltekian KM, et al (1995). Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population. Hepatology ;22:432-438

10) Velazquez RF, Rodriguez M, Navascues CA , et al. (2003) Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology;37:520-527

46

11) Llovet JM, Burroughs A, Bruix J.(2003) Hepatocellular carcinoma. Lancet ;362:1907- 1917

12) Sheu JC, Sung JL, Chen DS, et al. (1985) Growth rates of asymptomatic hepatocellular carcinoma and its clinical implications. Gastroenterology ;89:259-266

13) Choi B.I., Kim C.W., Han M.C. et al.: Sonographic characteristics of small hepatocellular carcinoma. Gastrointest Radiol 1989; 14: 255-261

14) D‟Onofrio M., Rozzanigo U., Caffarri S. et al.: Contrast-enhanced US of hepatocellular carcinoma. Radiol Med 2004; 107: 293-303

15) European Association for the Study of the Liver (Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Disease. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-1236

16) Chezmar JL, Rumaneik WM, Megibow AJ. Liver and abdominal screening in patients with cancer: CT versus MR imaging. Radiology 1987; 165: 399-406

17) Araki T., Itai Y., Furui S. et al.: Dynamic CT densitometry of hepatic tumors. AJR Am J Roentgenol 1980; 135: 1037-1043

18) Schoellnast H, Brader P, Oberdabernig B, Pisail B, Deutschmann HA, Fritz GA, Schaffler G, Tillich M. High.concentration contrast media in multiphasic abdominal multidetector-row computed tomography: effect of increased iodine flow rate on paranchymal and vascular enhancement. J Comput Assist Tomogr 2005; 29(5):582-7

19) Shellock FG, Kanal E. Safety of magnetic resonance imaging contrast agents. J Magn Reson Imaging 1999; 10: 477-484

20) Earls J.P., Theise N.D., Weinreb J.C. et al.: Dysplastic nodules and hepatocellular carcinoma: thin-section MR imaging of explanted cirrhotic livers with pathologic correlation. Radiology 1996; 201: 207-214

47

21) Yamashita Y., Fan Z.M., Yamamoto H. et al.: Spin-echo and dynamic gadolinium- enhanced FLASH MR imaging of hepatocellular carcinoma: correlation with histopathologic findings. J Magn Reson Imaging 1994; 4: 83-90

22) Inoue E., Kuroda C., Fujita M. et al.: MR features of various histological grades of small hepatocellular carcinoma. J Comput Assist Tomogr 1993; 17: 75-79

23) Krinsky G.A., Lee V.S., Theise N.D. et al.: Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 2001; 219: 445-454

24) Ebara M., Fukuda H., Kojima Y. et al.: Small hepatocellular carcinoma: relationship of signal intensity to histopathologic findings and metal contento f the tumor and surrounding hepatic parenchyma. Radiology 1999; 210: 81-88

25) Marti-Bonmati L.: MR imaging characteristics of hepatic tumors. Eur RADIOL 1997, 7. 249-258

26) Kadoya M., Matsui O., Takashima T. et al.: Hepatocellular carcinoma: correlation of MR imaging and histopathologic findings. Radiology 1992; 183: 819-825

27) Rode A., Bancel B., Douek P. et al.: Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 2001; 25: 327-336

28) Lim J.H., Choi D., Cho S.K. et al.: Conspicuity of hepatocellular nodular lesions in cirrhotic livers at ferumoxides-enhanced ME imaging: importance of Kupffer cell number. Radiology 2001; 220: 669-676

29) Tweedle MF. Physicochemical properties of gadoteridol and other magnetic resonance contrast agents. Invest Radiol 1992; 27:1-6

48

for MRI. In: Rinck PA (ed): Contrast and contrast agents in magnetic resonance imaging: European Workshop on Magnetic Resonance in Medicine, State University Mons, Belgium, 1989:135-48

31) Larson RE, Semelka RC, Bagley AS, Molina PL, Brown ED, Lee JK. Hypervascular malignant liver lesions: comparison of various MR imaging pulse sequences and dynamic CT. Radiology 1994; 192: 393-399

32) Semelka RC, Worawattanakul S, Kelekis NL, John G. Woosley JT, Graham M, Cance WG. Liver lesion detection, characterization, and effect on patient management: comparison of single.phase spiral CT and current MR techniques. J Magn Reson Imaging 1997; 7: 1040- 1047

33) Hahn PF, Saini S. Liver-specific MR imaging contrast agents. Radiol Clin North Am 1998; 36: 287-297

34) Reimer P, Schneider G, Schima W. Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 2004; 14(4): 559-78

35) Baleriaux D, Colosimo C, Ruscalleda J, Korves M, Schneider G, Bohndorf K, Bongartz G, van Buchem MA, Reiser M, Sartor K, Bourne MW, Parizel PM, Cherryman GR, Salerio I, La Noce A, Pirovano G, Kirchin MA, Spinazzi A. Magnetic Resonance imaging of metastatic disease to the brain with gadobenate dimeglumine. Neuroradiol 2002; 44: 191-203

36) Schneider G, Maas R, Schultze Kool L, Rummeny E, Gehl HB, Lodemann K, Kirchin MA. Low-dose gadobenate dimeglumine versus standard dose gadopentate dimeglumine for contrast-enhanced magnetic resonance imaging of the liver: an intra-individual crossover comparison. Invest Radiol 2003; 38: 85-94

37) Schumann-Giampieri G, Schmitt-Willich H, Press WR, Negishi C, Weimann HJ, Speck U.

49

Preclinical evaluation of Gd-EOB-DTPA as a contrast agent in MR imaging of the hepatobiliary system. Radiology 1992; 183: 59-64

38) Schuhmann-Giampieri G, Mahler M, Roll G, Maibauer R, Schmitz S. Pharmacokinetics of the liver-specific contrast agent Gd-EOB-DTPA in relation to contrast-enhanced liver imaging in humans. J Clin Pharmacol 1997; 37: 587-96

39) Bernd Hamm, MD; Thomas Staks, MD; Andreas Mühler, MD; Matthias Bollow, MD; Matthias Taupitz, MD; Thomas Frenzel, PhD; Karl-Jürgen Wolf, MD; Hanns-Joachim Weinmann, PhD; Lothar Lange, MD: Clinical Evaluation of Gd-EOB-DTPA as a Hepatobiliary MR Contrast Agent: Safety, Pharmacokinetics, and MR Imaging; Radiology 1995; 195:785-792

40) Peter Reimer, MD; Ernst J. Rummeny, MD; Kohkan Shamsi, MD; Thomas Balzer, MD; Heike E. Daldrup, MD; Bernd Tombach, MD; Tanja Hesse; Thomas Berns, MD; Peter E. Peters, MD: Phase II Clinical Evaluation of GD-EOB-DTPA: Dose, Safety Aspects, and Pulse Sequence; Radiology 1996; 199: 177-183

41) Ito 2006

42) Bartolozzi et al. 2001 43) Ramalho et al. 2007 44) Merkle and Nelson 2006 45) Lavelli et al. 2001 46) Mori et al. 2005

47) [Monawa S, Ichikawa T, Nakajama H, et al. Dynamic CT for detecting small hepatocellular carcinoma: usefulnessof delayed phase imaging. AJR 2007; 188:147-153] 48) Nakashima O, Sugihara S, Kage M, et al. Pathomorphologic characteristics of small hepatocellular carcinoma: a special reference to small hepatocellular carcinoma with

50

indistinct margins. Hepatology 1995;22(1):101–5

49) Kojiro M, Nakashima O. Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis 1999;19(3):287–96

50) Nakamura K, Zen Y, Sato Y, et al.Vascular endothelial growth factor, its receptor Flk-1, and hypoxia inducible factor-1a are involved in malignant transformation in dysplastic nodules of the liver. Human Pathology (2007) 38, 1532– 1546

51) Lim JH, Kim MJ, Park CK, et al. Dysplastic nodules in liver cirrhosis: detection with triple phase helical dynamic CT. The British Journal of Radiology, 77 (2004), 911–916