Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Advances in Understanding Hepatocellular Carcinoma Vasculature: Implications for Diagnosis, Prognostication, and Treatment

  • Hyungjin Rhee (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine) ;
  • Young Nyun Park (Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project, Severance Hospital, Yonsei University College of Medicine) ;
  • Jin-Young Choi (Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2024.03.30
  • Accepted : 2024.07.31
  • Published : 2024.10.01
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Abstract

Hepatocellular carcinoma (HCC) progresses through multiple stages of hepatocarcinogenesis, with each stage characterized by specific changes in vascular supply, drainage, and microvascular structure. These vascular changes significantly influence the imaging findings of HCC, enabling non-invasive diagnosis. Vascular changes in HCC are closely related to aggressive histological characteristics and treatment responses. Venous drainage from the tumor toward the portal vein in the surrounding liver facilitates vascular invasion, and the unique microvascular pattern of vessels that encapsulate the tumor cluster (known as a VETC pattern) promotes vascular invasion and metastasis. Systemic treatments for HCC, which are increasingly being used, primarily target angiogenesis and immune checkpoint pathways, which are closely intertwined. By understanding the complex relationship between histopathological vascular changes in hepatocarcinogenesis and their implications for imaging findings, radiologists can enhance the accuracy of imaging diagnosis and improve the prediction of prognosis and treatment response. This, in turn, will ultimately lead to better patient care.

Keywords

Acknowledgement

Illustrations (Fig. 5, Fig. 7, Supplementary Fig. 1A) were created with BioRender.com.

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