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Imaging of multifocal liver lesions in children and adolescents.

Hegde SV, Dillman JR, Lopez MJ, Strouse PJ - Cancer Imaging (2013)

Bottom Line: Multifocal liver lesions are encountered regularly in children and adolescents.By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis.The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

View Article: PubMed Central - PubMed

Affiliation: Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT
Multifocal liver lesions are encountered regularly in children and adolescents. By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis. The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

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A 14-year-old boy with a remote history of rhabdomyosarcoma and 7 FNHs. (a,b) Axial T2-weighted fast spin echo fat-saturated and T1-weighted GRE in-phase MR images show a circumscribed lesion in the right hepatic lobe (arrows) that is subtly T2-weighted hyperintense and T1-weighted hypointense. Central stellate T2-weighted signal hyperintensity within the lesion (arrowhead) is compatible with a central scar. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast image demonstrates avid hyperenhancement of the lesion (arrow) compared with normal adjacent liver, whereas the lesion (arrow) appears nearly isointense to adjacent normal liver on a 5-min delayed postcontrast image (d). Other liver lesions (not shown) had similar imaging features.
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Figure 2: A 14-year-old boy with a remote history of rhabdomyosarcoma and 7 FNHs. (a,b) Axial T2-weighted fast spin echo fat-saturated and T1-weighted GRE in-phase MR images show a circumscribed lesion in the right hepatic lobe (arrows) that is subtly T2-weighted hyperintense and T1-weighted hypointense. Central stellate T2-weighted signal hyperintensity within the lesion (arrowhead) is compatible with a central scar. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast image demonstrates avid hyperenhancement of the lesion (arrow) compared with normal adjacent liver, whereas the lesion (arrow) appears nearly isointense to adjacent normal liver on a 5-min delayed postcontrast image (d). Other liver lesions (not shown) had similar imaging features.

Mentions: Focal nodular hyperplasia (FNH) is a hamartomatous liver lesion containing non-malignant hepatocytes, fibrous tissue, bile ducts, malformed blood vessels, and Kupffer cells[1]. Although the exact cause of this lesion is often uncertain, it is generally thought to be due to an underlying hepatic vascular disturbance. FNHs are seen with increased frequency in long-term survivors of childhood malignancies, perhaps a complication of chemotherapy or abdominal radiotherapy[2]. FNHs are very commonly multifocal in this setting (Figs. 1 and 2)[2].Figure 1


Imaging of multifocal liver lesions in children and adolescents.

Hegde SV, Dillman JR, Lopez MJ, Strouse PJ - Cancer Imaging (2013)

A 14-year-old boy with a remote history of rhabdomyosarcoma and 7 FNHs. (a,b) Axial T2-weighted fast spin echo fat-saturated and T1-weighted GRE in-phase MR images show a circumscribed lesion in the right hepatic lobe (arrows) that is subtly T2-weighted hyperintense and T1-weighted hypointense. Central stellate T2-weighted signal hyperintensity within the lesion (arrowhead) is compatible with a central scar. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast image demonstrates avid hyperenhancement of the lesion (arrow) compared with normal adjacent liver, whereas the lesion (arrow) appears nearly isointense to adjacent normal liver on a 5-min delayed postcontrast image (d). Other liver lesions (not shown) had similar imaging features.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3569672&req=5

Figure 2: A 14-year-old boy with a remote history of rhabdomyosarcoma and 7 FNHs. (a,b) Axial T2-weighted fast spin echo fat-saturated and T1-weighted GRE in-phase MR images show a circumscribed lesion in the right hepatic lobe (arrows) that is subtly T2-weighted hyperintense and T1-weighted hypointense. Central stellate T2-weighted signal hyperintensity within the lesion (arrowhead) is compatible with a central scar. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast image demonstrates avid hyperenhancement of the lesion (arrow) compared with normal adjacent liver, whereas the lesion (arrow) appears nearly isointense to adjacent normal liver on a 5-min delayed postcontrast image (d). Other liver lesions (not shown) had similar imaging features.
Mentions: Focal nodular hyperplasia (FNH) is a hamartomatous liver lesion containing non-malignant hepatocytes, fibrous tissue, bile ducts, malformed blood vessels, and Kupffer cells[1]. Although the exact cause of this lesion is often uncertain, it is generally thought to be due to an underlying hepatic vascular disturbance. FNHs are seen with increased frequency in long-term survivors of childhood malignancies, perhaps a complication of chemotherapy or abdominal radiotherapy[2]. FNHs are very commonly multifocal in this setting (Figs. 1 and 2)[2].Figure 1

Bottom Line: Multifocal liver lesions are encountered regularly in children and adolescents.By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis.The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

View Article: PubMed Central - PubMed

Affiliation: Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT
Multifocal liver lesions are encountered regularly in children and adolescents. By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis. The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.

Show MeSH
Related in: MedlinePlus