Evaluating Hypervascular Hepatocellular Carcinoma

The inclusion criteria for consecutive 62 HCC patients who were seen between July 2019 and December 2020 were as follows: (a) the HCC diagnosis was based on pathologic proof of the tumor burden obtained after partial hepatectomy, (b) patients who underwent preoperative hepatic dynamic CT acquired with DL-SCTI plus CTHA studies. Hypervascular HCCs should be evaluated accurately because they are much more aggressive than hypovascular HCCs^{4 (link),17 (link)}. Raw data of DL-SCTI scanning is required for reconstruction of iodine maps. Thus, the exclusion criteria were as follows: (a) patients with HCCs which were hypovascular, (b) raw data of DL-SCTI scanning was not stored. Tumor vascularity was confirmed with CTHA. One board-certified radiologist (KN with 7 years of experience in radiology) placed ROIs on the tumor and the surrounding hepatic parenchyma and calculated the contrast ratio (CR) on CTHA images as CR = ROI_T/ROI_L, where ROI_T is the mean attenuation of the tumor, and ROI_L the mean attenuation of the liver parenchyma. HCCs with a CR > 1.0 were defined as hypervascular^{18 (link)}. KN also confirmed the presence and location of hypervascular HCCs on dynamic CT images. Finally, this study evaluated 52 patients with hypervascular HCCs (37 men, 15 women; age range 50–88 years, median age 70.0 years). All 52 patients had chronic liver disease and its underlying causes were hepatitis B (n = 15), hepatitis C (n = 24), alcoholic chronic hepatitis (n = 3), nonalcoholic steato-hepatitis (n = 6), autoimmune hepatitis (n = 1), primary biliary cirrhosis (n = 1), and unknown (n = 2).