Celiac Angiography in the Diagnosis of Small Hepatocellular Carcinoma

  • Kenichi Takayasu
  • Kunio Okuda


Celiac angiography is indispensable in the diagnosis of hepatic tumors, particularly hepatocel-lular carcinoma (HCC). The characteristic, if not pathognomonic, angiographic findings of HCC include tumor vessels, bizarre vascular lakes or conduits, hypervascularity, arterioportal shunts, and intraportal tumor invasion [1–5], identified as the thread and streaks sign [6]. However, these findings are derived from studies of advanced cases of HCC. With the advent of various newer imaging techniques, the diagnostic significance of angiography is changing. Currently, small HCCs are mostly detected by ultrasonography (US) in Japan and Taiwan and perhaps in some regions of China and Southeast Asia. The established diagnostic policy for early detection of HCC in these areas has been to follow patients with chronic liver disease by regularly scheduled checkups using abdominal US and serum alpha-fetoportein (AFP) measurements [7–9]. Small lesions are often detected among such patients and the lesions mostly prove to be HCC. The usual sequence of diagnostic investigations that follow the detection of a small-mass lesion by US involves CT scan followed by angiography and, finally, perhaps by US-guided biopsy [10]. Although CT scan and angiography are not sufficiently sensitive for the demonstration of lesions smaller than 2 cm, both modalities are necessary, particularly the latter, in patients under consideration for an operation or hepatic resection. The following discussion summarizes our experience with angiography in the diagnosis of HCC smaller than 5 cm in diameter.


Tumor Vessel Cirrhotic Liver Angiographic Finding Small Hepatocellular Carcinoma Hepatic Arteriography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Boijsen E, Abrams HL (1965) Roentgenologic diagnosis of primary carcinoma of the liver. Acta Radiol(Diag) 3:257–277Google Scholar
  2. 2.
    Nebesar RA, Pollard JJ, Stone DL (1966) Angiographic diagnosis of malignant disease of the liver. Radiology 86:284–292PubMedGoogle Scholar
  3. 3.
    Reuter ST, Redman HC, Siders DB (1970) The spectrum of angiographic findings in hepatoma. Radiology 94:89–94PubMedGoogle Scholar
  4. 4.
    Okuda K, Obata H, Jinnouchi S, Kubo Y, Nagasaki Y, Shimokawa Y, Nakajima Y, Musha H, Sakamoto K, Kojiro M, Nakashima T (1977) Angiographie assessment of gross anatomy of hepatocellular carcinoma: comparison of celiac angiograms and liver pathology in 100 cases. Radiology 123:21–29PubMedGoogle Scholar
  5. 5.
    Okuda K, Iio M (1976) Radiological aspects of the liver and biliary tract. X-ray and radioisotope diagnosis. Year Book, ChicagoGoogle Scholar
  6. 6.
    Okuda K, Musha H, Yoshida T, Kanda Y, Jinnouchi S, Kubo Y, Shimokawa Y, Kojiro M, Sakamoto K, Nakashima T (1975) Demonstration of growing casts of hepatocellular carcinoma in the portal vein by celiac angiography: the thread and streaks sign. Radiology 117: 303–309PubMedGoogle Scholar
  7. 7.
    Shinagawa T, Ohto M, Kimura K, Tsunetomi S, Morita M, Saisho H, Tsuchiya Y, Saotome N, Karasawa E, Miki M, Ueno T, Okuda K (1984) Diagnosis and clinical features of small hepatocellular carcinoma with emphasis on the utility of real-time ultrasonography. A study in 51 patients. Gastroenterology 86:495–502PubMedGoogle Scholar
  8. 8.
    Chen DS, Shen JC, Sung JL, Sheu JC, Lai MY, How SW, Hsu HC, Lee CS, Wei TC (1983) Small hepatocellular carcinoma—a clinicopathological study in thirteen patients. Gastroenterology 83:1109–1119Google Scholar
  9. 9.
    Okazaki N, Yosida T, Yoshino M, Matue H (1984) Screening of patients with chronic liver disease for hepatocellular carcinoma by ultrasonography. Clin Oncol 10:241–246PubMedGoogle Scholar
  10. 10.
    Ohto M, Karasawa E, Tsuchiya Y, Kimura K, Saisho H, Ono T, Okuda K (1980) Ultrasonically guided percutaneous contrast medium injection and aspiration biopsy using a real-time puncture transducer. Radiology 136:171–176PubMedGoogle Scholar
  11. 11.
    Prando A, Wallace S, Bernardino ME, Lindell MM Jr (1979) Computed tomographic arteriography of the liver. Radiology 130:689–697Google Scholar
  12. 12.
    Sumida M, Ohto M, Ebara M, Kimura K, Okuda K, Hirooka N (1986) Accuracy of angiography in the diagnosis of small hepatocellular carcinoma. Am J Roentgenol 147: 531–536CrossRefGoogle Scholar
  13. 13.
    Okuda K, Musha H, Nakajima Y, Kubo Y, Shimokawa Y, Nagasaki Y, Jinnouchi S, Obata H, Hisamitsu T, Okazaki N, Kojiro M, Sakamoto K, Nakashima T (1977) Clinicopathologic features of encapsulated hepatocellular carcinoma. A study of 26 cases. Cancer 40:1240–1245PubMedCrossRefGoogle Scholar
  14. 14.
    Bross IDJ (1958) How to use ridit analysis. Bio-metrics 14:18–38Google Scholar
  15. 15.
    Edmondson HA, Steiner PE (1954) Primary carcinoma of the liver. A study of 100 cases among 48,900 necropsies. Cancer 7:462–503PubMedCrossRefGoogle Scholar
  16. 16.
    Arakawa M, Sugihara S, Kenmochi K, Kage M, Nakashima T, Nakayama T, Tashiro S, Hiraoka H, Suenaga M, Okuda K (1986) Small mass lesions in cirrhosis: transition from benign adenomatous hyperplasia to hepatocellular carcinoma? J Gastroenterol Hepatol 1:3–14CrossRefGoogle Scholar
  17. 17.
    Arakawa M, Kage M, Sugihara S, Nakashima T, Suenaga M, Okuda K (1986) Emergence of malignant lesions within an adenomatous hyperplastic nodule in a cirrhotic liver. Observations in five cases. Gastroenterology 91:198–208PubMedGoogle Scholar
  18. 18.
    Takayasu K, Shima Y, Muramatsu Y, Goto H, Moriyama N, Yamada T, Makuuchi M, Yamasaki S, Hasegawa H, Okazaki N, Hirohasi S, Kishi K (1986) Angiography of small hepatocellular carcinoma: analysis of 105 resected tumors. Am J Roentgenol 147:525–529CrossRefGoogle Scholar
  19. 19.
    Kendall MG (1962) Rank correlation methods, 3rd edn. Griffin, LondonGoogle Scholar
  20. 20.
    Young SW, Turner RJ, Castellino RA (1980) A strategy for the contrast enhancement of malignant tumors using dynamic computed tomography and intravascular pharmacokinetics. Radiology 137:137–147PubMedGoogle Scholar

Copyright information

© Springer Japan 1987

Authors and Affiliations

  • Kenichi Takayasu
    • 1
  • Kunio Okuda
    • 2
  1. 1.Department of Diagnostic RadiologyNational Cancer Center HospitalTsukiji, Tokyo, 104Japan
  2. 2.First Department of MedicineChiba University School of MedicineInohana, Chiba, 280Japan

Personalised recommendations