血清miR-378a-5p水平联合微血流成像的超声多模态检查对肝癌疾病进展与微血管侵犯的评估价值

目的探讨血清miR-378a-5p水平联合微血流成像的超声多模态检查对肝癌疾病(HCC)进展与微血管侵犯(MVI)的评估价值。方法选取HCC患者100例作为研究对象,根据诊断结果分为MVI组(n=60)、非MVI组(n=40)。应用实时荧光定量PCR法检测血清miR-378a-5p mRNA相对表达量;应用Philips彩超诊断仪进行微血流成像的超声多模态检查。分析HCC不同分期血清指标和超声表现差异;将MVI的危险因素进行单因素分析,将甲胎蛋白(AFP)、癌胚抗原(CEA)、miR-378a-5p进行多因素Logistic回归分析,分析血清miR-378a-5p、联合微血流成像的超声多模态检查单独及联合检测对MVI预测价值。结果HCCⅠ期、Ⅱ期、Ⅲ期动脉相、门脉相造影及血清miR-378a-5p水平比较,差异具有统计学意义(P<0.05);单因素分析显示,两组性别、年龄、体质量、肿瘤位置比较,差异无统计学意义(P>0.05);MVI组包膜破损、无包膜、微血流Ⅱ级、Ⅲ级、门脉相高增强、肿瘤不光滑边缘、AFP、CEA、miR-378a-5p、SBP、DBP高于非MVI组,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,血清CEA、微血流分级、miR-378a-5p为发生MVI的独立危险因素(P<0.05);ROC结果显示,血清miR-378a-5p、联合微血流成像的超声多模态检查单独预测MVI的最佳截断点分别为2.655 ng/mL、44.35μg/mL,单独及联合预测MVI预后不良的AUC分别为0.731、0.697、0.852。结论HCC患者不同分期超声表现及血清miR-378a-5p水平不同,且MVI患者血清miR-378a-5p低表达,血清miR-378a-5p联合微血流成像的超声多模态检查对早期MVI检测具有较高诊断价值。

基于蛋白质相互作用网络局部相似度的肝癌疾病基因预测

基于人类蛋白质相互作用网络,该文采纳拓扑局部相似度去实现肝癌疾病基因的预测.交叉检验测试结果表明:有22%~29%的目标基因在候选基因中排名前5%,且预测精度均能达到0.7以上.归因于低的计算复杂度和相对高的预测精度,这类疾病基因预测方法可为发现和鉴定疾病基因提供有力的线索.

螺旋CT多期扫描与血清CXCL13、NGAL联合检测在肝癌疾病中的诊断意义

目的 分析螺旋CT多期扫描与血清CXCL13、NGAL联合检测在肝癌疾病中的诊断意义。方法 选择2014年5月至2018年1月在两院进行治疗的疑似肝癌疾病患者67例作为研究对象,入组患者均进行螺旋CT多期扫描,采用ELISA法测定患者血清CXCL13、NGAL水平。结果 肝癌组血清NGAL、CXCL13水平显著高于非肝癌组,统计学分析结果表明差异具有统计学意义(P<0.05)。螺旋CT对肝癌疾病诊断的灵敏度、准确性、特异性、阳性预测值和阴性预测值分别为0.89、0.87、0.62、0.95和0.47,从中可以看出该方法的特异性和阴性预测值均偏低。血清标志物对肝癌疾病诊断的灵敏度、准确性、特异性、阳性预测值和阴性预测值分别为0.88、0.87、0.78、0.96和0.51。螺旋CT联合血清标志物肝癌疾病诊断的灵敏度、准确性、特异性、阳性预测值和阴性预测值分别为0.97、0.95、0.88、0.98和0.80。结论 螺旋CT多期扫描与血清CXCL13、NGAL联合检测在肝癌疾病诊断的灵敏度、准确性及特异性均较高,同时具有较高的阴性预测值和阳性预测值,具有较好的临床应用价值。

彩色多普勒超声诊断对肝癌疾病诊断的临床价值研究

目的观察与探究彩色多普勒超声诊断在肝癌疾病诊断中临床价值,为临床提供治疗依据。方法选取2013年2月~2017年10月本院接收的48例肝癌患者的临床资料进行分析,对48例患者的超声图像进行分析,同时分析患者病理类型、病灶大小不同,分析血流信号结果并比较不同病灶血流分型情况。结果 48例原发性肝癌患者共有56个病灶,直径>3 cm,形态不规则,有压迫肝内血管现象,门静脉沿其边缘绕行较少病灶周围有环状声晕;一部分病灶见低回声,在患者病灶区域回声低于周围肝组织,直径<3 cm,形态规则,与周围肝组织分界清楚;病灶较大,肝组织发生坏死、液化、出血,病灶回声为混合型。本次参与研究的48例患者其彩色多普勒超声显示大于3 cm的肿瘤,Ⅰ型6例(33.34%),Ⅱ型8(44.44%),Ⅲ型4(22.22%),而小于3 cm的癌肿Ⅰ型4(10.53%),Ⅱ型7(18.42%),Ⅲ型为27(71.05%),差异有统计学意义P<0.05,患者病变区Vmax为(32~106)cm/s,RI为0.41~0.81。结论对临床肝癌患者行彩色多普勒超声诊断,能够准确找到患者肿瘤位置,了解病灶数量、转移情况等等,第一时间了解患者病情,作为临床治疗的依据,具有一定临床应用加之,值得临床推广及应用。

彩色多普勒超声诊断对肝癌疾病诊断的临床价值分析

检验彩色多普勒超声诊断对肝癌疾病诊断的临床价值。方法 2021年11月至2023年11月,纳入经由病理诊断确诊为肝癌的病人76例。予以其彩色多普勒超声检查,对检查结果进行回顾性分析。评析彩色多普勒超声诊断率、不同病灶血流分型、不同病程患者血流参数指标。结果 (1)彩色多普勒超声诊断率与病理检查相比,无较大差异,P>0.05。(2)病灶≤3cm组患者的病灶血流分型以Ⅱ型居多,而>3cm组则以Ⅲ型占比较高,P<0.05(3)转移组肝动脉峰值流速低于原发组,肝动脉内径比原发组小,其余指标,如肝动脉最小流速、门静脉流速等,比原发组高,P<0.05。结论 肝癌疾病诊断中,以彩色多普勒超声进行诊断,可提高疾病检出率,明确病灶血流情况,对指导临床治疗方案的选择具有重要意义。

彩色多普勒超声诊断对肝癌疾病诊断的临床价值及准确性分析

探究彩色多普勒超声在肝癌疾病诊断中的价值、准确性。方法 取肝癌疾病患者50例,以其为依据,开展本次研究,分析资料,50例患者均通过病理结果确诊,但在确诊病情前,均实施过彩色多普勒超声检查。结果 50例患者通过病理检查,所用患者均具有明确的病情,其中多数病灶的直径超过了3cm,28例为原发性肝癌,22例为转移性肝癌。在彩色多普勒超声检查下,检出肝癌48例,其中有25例为原发性,有23例为转移性,检查诊断符合率相较于病理结果,无差异,P>0.05;而且在此类检查中,会通过不同的特征观察到原发性与转移性肝癌。血流参数对比,原发性肝瘤血供明显,且肝动脉内径、峰值流速高于转移肝癌者,P<0.05。对比不同的病灶彩色多普勒超声血液分型情况,发现病灶低于3cm的患者,1型、2型所占比率明显高于病灶超过3cm患者,而3型占比率低于病灶超过3cm者,P<0.05。结论 在肝癌疾病诊断中采用彩色多普勒超声检查,可以提高诊断符合率,并通过血液流动参数评估病情,为诊治工作的顺利开展提供有效的依据,值得推广。

肝癌与其他疾病关联性的医疗大数据挖掘

目的:基于医疗大数据平台对肝癌患者的病案数据进行分析挖掘,发现肝癌与其他疾病之间的相关性关系。方法:从医疗大数据平台获取符合分析条件的肝癌相关病案的诊断数据,利用Python编程语言进行数据清洗与整理,运用共现分析和中心性分析方法进行网络分析,并通过Gephi网络软件进行可视化展示。结果:共获取符合分析条件的患者诊断数据3457个,相关病历5317份。其中性别字段3475个,患者年龄字段3462个。出院诊断字段筛选词频≥3的诊断词12592个,以此构建的疾病相关性网络中包含肝癌与继发性肿瘤、肝癌与常见慢性病、肝癌与囊肿类疾病、肝癌相关危险因素及并发症、肝癌与电解质紊乱及器官功能异常、肝癌与其他疾病6个类团。结论:男性肝癌患者多于女性肝癌患者,年龄主要分布在40~65岁。肝癌患者肿瘤转移率普遍较高,肝癌与电解质紊乱存在一定关联性,心血管疾病和囊肿类疾病与肝癌联系紧密,仍需进一步深入研究。

肝癌癌前疾病恶性转换的潜在机制

肝癌是全球范围内最常见的恶性肿瘤之一,是目前全球最常见的第二肿瘤的死因。由于肝癌的早期症状不是很明显,很多患者在诊断肝癌时已经处于肝癌晚期的阶段,尽早诊断肝癌对肝癌治疗和疾病预后非常的重要。肝癌癌前疾病具有转化为肝癌的风险,因此,肝癌癌前疾病的研究对肝癌的早期诊断至关重要,有助于完善肝癌的诊治模式。

山仙颗粒对大鼠肝癌前病变Wnt/β-catenin信号通路相关蛋白表达水平的影响

目的观察山仙颗粒对二乙基亚硝胺诱导的大鼠肝癌前病变的影响及可能的分子机制。方法雄性大鼠90只,体质量约(190±10)g,随机分为空白组,模型组,山仙颗粒大、中、小剂量组和KYA1797K(Wnt抑制剂)组,每组15只。采用腹腔注射二乙基亚硝胺诱导大鼠肝癌前病变模型,给药16周后处死。抽血检测肝功能指标ALT(谷丙转氨酶)、AST(谷草转氨酶)、GGT(谷氨酰转肽酶);取肝脏组织,观察并记录其大小、质地、外观等变化;HE、Masson染色观察大鼠肝脏组织病理形态学改变;采用实时荧光定量PCR(聚合酶链反应)及Western blot法检测肝组织中Wnt/β-catenin(肝癌相关)信号通路Wnt-3a、β-catenin、c-MycmRNA和蛋白质的表达含有量。结果与模型组比较,大、中剂量山仙颗粒分别明显减轻了肝功能损伤和肝脏的病变程度(P<0.01,P<0.05),下调了Wnt/β-catenin信号通路Wnt3a、β-catenin、c-Myc mRNA(P<0.01,P<0.05)和蛋白质的表达(P<0.01,P<0.05)。结论山仙颗粒能明显减轻大鼠肝癌前病变形态学的改变,其机制可能是通过抑制Wnt/β-catenin信号通路的活化、下调其下游靶基因的表达水平。

Hepatocellular carcinoma: Therapy and prevention

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. The major etiologies and risk factors for the development of HCC are well defined and some of the multiple steps involved in hepatocarcinogenesis have been elucidated in recent years. Despite these scientific advances and the implementation of measures for the early detection of HCC in patients at risk, patient survival has not improved during the last three decades. This is due to the advanced stage of the disease at the time of clinical presentation and limited therapeutic options. The therapeutic options fall into five main categories: surgical interventions including tumor resection and liver transplantation, percutaneous interventions including ethanol injection and radiofrequency thermal ablation, transarterial interventions including embolization and chemoembolization, radiation therapy and drugs as well as gene and immune therapies. These therapeutic strategies have been evaluated in part in randomized controlled clinical trials that are the basis for therapeutic recommendations. Though surgery, percutaneous and transarterial interventions are effective in patients with limited disease (1-3 lesions, ＜5 cm in diameter) and compensated underlying liver disease (cirrhosis Child A), at the time of diagnosis more than 80% patients present with multicentric HCC and advanced liver disease or comorbidities that restrict the therapeutic measures to best supportive care. In order to reduce the morbidity and mortality of HCC, early diagnosis and the development of novel systemic therapies for advanced disease, including drugs, gene and immune therapies as well as primary HCC prevention are of paramount importance. Furthermore, secondary HCC prevention after successful therapeutic interventions needs to be improved in order to make an impact on the survival of patients with HCC. New technologies, including gene expression profiling and proteomic analyses, should allow to further elucidate the molecular events underlying HCC development and to identify novel diagnostic markers as well as therapeutic and preventive targets.

Risk factors for primary liver carcinoma in Chinese population

AIM： To evaluate the risk factors for primary liver carcinoma （PLC） in Chinese population.METHODS： Chinese Biomedical Literature Database, China Hospital Knowledge Database and MEDLINE were searched. All the related literatures were screened, and the risk factors for PLC in Chinese population were studied. Heterogeneity was evaluated by odds ratio （OR） q test. Combined OR and its 95% confidence interval （95%CI）were calculated, the association between the investigated risk factors and PLC was determined. Validity and bias of the findings were evaluated by sensitivity analysis and funnel plot analysis respectively.RESULTS： Fifty-five of one hundred and ninety identified studies were accepted according to the inclusive criteria. Ten factors related to PLC were demonstrated by sensitive analysis and funnel plot analysis. They were cirrhosis （OR = 11.97, P= 0.000）, HBV infection （OR = 11.34, P= 0.000）,HCV infection （OR = 4.28, P = 0.000）, family history of liver cancer （OR = 3.49, P = 0.000）, unstable emotion （OR = 2.20, P = 0.000）, depressed characters （OR = 3.07,P = 0.000）, aflatoxin （OR = 1.80, P = 0.000）, alcoholic （OR = 1.88, P = 0.000）, intake of musty food （OR =1.87,P = 0.000） and drinking contaminated water from pond （OR = 1.77, P = 0.003）.CONCLUSION： The main risk factors for PLC in China are liver diseases, family history of liver carcinoma, poor psychic status, aflatoxin, and some unhealthy behaviors.

Combination of repeated single-session percutaneous ethanol injection and transarterial chemoembolisation compared to repeated single-session percutaneous ethanol injection in patients with non-resectable hepatocellular carcinoma

AIM： To evaluate the treatment effect of percutaneous ethanol injection （PEI） for patients with advanced, non-resectable HCC compared with combination of transarterial chemoembolisation （TACE） and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. METHODS： All patients who received PEI treatment during the study period were included and stratified to one of the following treatment modalities according to physical status and tumor extent： combination of TACE and repeated single-session PEI, repeated single-session PEI alone, repeated TACE alone, or best supportive care. Prognostic value of clinical parameters including Okuda-classification, presence of portal vein thrombosis, presence of ascites, number of tumors, maximum tumor diameter, and serum cholinesterase （CHE）, as well as Child-Pugh stage, α-fetoprotein （AFP）, fever, incidence of complications were assessed and compared between the groups. Survival was determined using Kaplan-Meier and multivariate regression analyses.

Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide with an annual occurrence of one million new cases. An etiologic association between HBV infection and the development of HCC has been established with a relative risk 200-fold greater than in non-infected individuals. Hepatitis C virus is also proving an important predisposing factor for this malignancy with an incidence rate of 7% at 5 years and 14% at 10 years. The prognosis depends on tumor stage and degree of liver function, which affect the tolerance to invasive treatments. Although surgical resection is generally accepted as the treatment of choice for HCC, new treatment strategies, such as local ablative therapies, transarterial embolization and liver transplantation, have been developed nowadays. With increasing detection of small HCCs from screening programs for cirrhotic patients, it is foreseen that locoregional therapy will play an important role in the near future.

Ectopic hepatocellular carcinoma arising from pancreas: A case report and review of the literature

A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.

Circulating DNA level is negatively associated with the long-term survival of hepatocellular carcinoma patients

AIM： To quantify the circulating DNA in plasma from patients with hepatocellular carcinoma （HCC） and to evaluate its prognostic value. METHODS： Blood samples were collected from 79 patients with HCC before operation, 20 patients with liver cirrhosis, and 20 healthy volunteers. Circulating DNA was extracted from plasma and quantified. The association between circulating DNA level and prognosis of HCC patients was evaluated. RESULTS： Compared with the healthy volunteers （17.6 ± 9.5 ng/mL）, a significant higher circulating DNA level was found in the patients with HCC （47.1 ± 43.7 ng/ mL, P = 0.000） or with liver cirrhosis （30.0 ± 13.3 ng/ mL, P = 0.002）. The circulating DNA level was closely associated with tumor size （P = 0.008） and TNM stage （P = 0.040）, negatively associated with the 3-year diseasefree survival （DFS） （P = 0.017） and overall survival （OS） （P = 0.001）. CONCLUSION： Large or invasive tumor may release more circulating DNA, and higher level of circulating DNA may be associated with poor prognosis of HCC patients.

Usefulness of serum des-γ-carboxy prothrombin in detection of hepatocellular carcinoma

AIM： To evaluate whether DCP is better than AFP for differentiating HCC from nonmalignant liver disease and further evaluate the usefulness of DCP in early diagnosis of small HCC. METHODS： Serum DCP and AFP levels were determined in 127 patients. Among these patients, 32 were with noncirrhotic chronic hepatitis, 34 were with compensated cirrhosis, and 61 were with HCC. The cut-off value for the DCP and AFP were set as 40 mAU/mL and 20 ng/mL, respectively. To compare the diagnostic value of DCP and AFP in distinguishing HCC from nonmalignant chronic liver disease, receiver operating characteristic （ROC） curves were constructed for each assay. RESULTS： The accuracy, sensitivity, and specifidty of DCP were higher than AFP in detecting HCC （81.9%, 77%, and 86.4% vs 68.5%, 59%, and 77.3%, respectively）. The area under the ROC （AUROC） curves revealed that DCP had a better accuracy than AFP in diagnosis of HCC （0.85 [95%CI, 0.78-0.91] vs 0.73 [95%CI, 0.65-0.81], P= 0.013）. In 39 patients with solitary HCC, the positive rates of DCP were 100% in patients with tumor size larger than 3 cm, 66.7% in patients with tumor size 2-3 cm and 50% in patients with tumor size less than 2 cm. The positive rates of AFP in patients with tumor size larger than 3 cm, 2-3 crn and less than 2 cm were 55.6%, 50%, and 33.3%, respectively. The median level of DCP in HCC patients with tumor size larger than 3 cm was significantly higher than those with tumor size 2-3 cm and those with the size of less than 2 cm. CONCLUSION： Our study indicates that DCP has a better diagnostic value than AFP in differentiating HCC from nonmalignant chronic liver disease. DCP has not only a stronger correlation with HCC than AFP in tumor size but also more effectiveness than AFP in detecting small size of HCC.

Mucinous cystadenoma of the appendix associated with adenocarcinoma of the sigmoid colon and hepatocellular carcinoma of the liver:Report of a case

Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of mucus inside it. Histopathologically mucocele is divided into three groups： focal or diffuse mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. This condition is often associated with other neoplasia, especially adenocarcinoma of the colon and ovaries. We here describe a 57 year old male patient who presented with abdominal discomfort, constipation, fresh blood in stool and frequent urination. He had a big cystadenoma of the appendix associated with adenocarcinoma of the colon and hepatocellular carcinoma of the liver. The patient underwent right haemicolectomy, sigmoid colon resection and segmental resection of the liven Now 3 years later he has no evidence of disease relapse. According to this, we stress the need of accurate preoperative diagnosis and intraoperative exploration of the whole abdomen in these patients.

Treatment for liver metastases from breast cancer: Results and prognostic factors

AIM: Liver metastases from breast cancer (BCLM) are associated with poor prognosis. Cytotoxic chemotherapy can result in regression of tumor lesions and a decrease in symptoms. Available data, in the literature, also suggest a subgroup of patients may benefit from surgery, but few talked about transcatheter arterial chemoembolization (TACE). We report the results of TACE and systemic chemotherapy for patients with liver metastases from breast cancer and evaluate the prognostic factors. METHODS: Forty-eight patients with liver metastases, from proved breast primary cancer were treated with TACE or systemic chemotherapy between January 1995 and December 2000. Treatment results were assessed according to WHO criteria, along with analysis of prognostic factors for survival using Cox regression model. RESULTS: The median follow-up was 28 mo (1-72 mo). Response rates were calculated for the TACE group and chemotherapy group, being 35.7% and 7.1%, respectively. The difference was significant. The one-, two- and three-year Survival rates for the TACE group were 63.04%, 30.35%, and 13.01%, and those for the systemic chemotherapy group were 33.88%, 11.29%, and 0%. According to univariate analysis, variables significantly associated with survival were the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight. Other factors such as age, the intervals between the primary to the metastases, the maximal diameter of the liver metastases, the number of liver metastases, extrahepatic metastasis showed no prognostic significances. These factors mentioned above such as the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight were also independent factors in multivariate analysis. CONCLUSION: TACE treatment of liver metastases from breast cancer may prolong survival in certain patients. This approach offers new promise for the curative treatment of the patients with metastatic breast cancer.

Comparison of childhood hepatic malignancies in a hepatitis B hyper-endemic area

AIM： To examine the differences of clinical behaviors between hepatocellular carcinomas （HCC） and hepatoblastomas （HB） in children. METHODS： From 1979 to 1997, we collected 73 HCC and 54 HB from two major medical centers in Taiwan. Demographic, laboratory and radiological data, and survival curves were statistically compared. RESULTS： HCC clinically differed from HB in mean age （10.6 vs2.5 years; P〈0.001）, status of hepatitis B infection （56/56 vs4/35, P〈0.001） and accompanying liver cirrhosis （26/40 vs 0/30, P〈0.001）, portal vein thrombi （22156 vs 5/38, P=0.006） and para-aortic lymphadenopathy （10/56 vs 1/38, P=0.026）. Due to a higher recurrence rate （7/12 vs 2/13, P=0.041）, stage I HCC compared poorly in survivals with stage I HB （P=0.0183）. Chemotherapy could only benefit HB as evidenced by 66.7% of resectability conversion and improve survivals for advanced HB, even with unsuccessful conversion. The survival difference between stage I HB and advanced HB with delayed complete resection was of borderline insignificance （P=0.0507）. CONCLUSION： I-ICC and HB were preliminarily distinguishable by some dinical dues. Delayed resection after chemotherapy was only possible for HB. However, further studies are needed to strengthen our observation that appropriate reliance upon chemotherapy to subsequently resect advanced HB could achieve the comparable survival to that of stage I HB.

Capability of multidetector CT to diagnose hepatocellular carcinoma-associated arterioportal shunt

AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis. RESULTS: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Fortyone severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA.CONCLUSION: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.