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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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Related in: MedlinePlus

A 13-year-old boy with incidentally detected large FNH. Late arterial phase postcontrast CT image shows a large hyperenhancing lesion within the posterior segment of the right hepatic lobe that has lobular circumscribed margins. The mass has a prominent hypoattenuating central scar that contains several small, tortuous, hepatic artery branches (arrowhead). Early opacification of the right hepatic vein (arrow) is due to arteriovenous shunting of blood. A second smaller arterially hyperenhancing lesion is not shown.
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Figure 3: A 13-year-old boy with incidentally detected large FNH. Late arterial phase postcontrast CT image shows a large hyperenhancing lesion within the posterior segment of the right hepatic lobe that has lobular circumscribed margins. The mass has a prominent hypoattenuating central scar that contains several small, tortuous, hepatic artery branches (arrowhead). Early opacification of the right hepatic vein (arrow) is due to arteriovenous shunting of blood. A second smaller arterially hyperenhancing lesion is not shown.

Mentions: At ultrasonography, FNHs are circumscribed, exert a local mass effect, and may appear hypoechoic, isoechoic, or hyperechoic[1]. On computed tomography (CT) and magnetic resonance imaging (MRI), FNHs appear as discrete lesions with circumscribed lobular margins (Figs. 1–3). On non-contrast CT, these lesions are isoattenuating/slightly hypoattenuating to normal liver, whereas they are typically mildly hypointense/isointense and mildly hyperintense/isointense on non-contrast T1-weighted and T2-weighted MRI, respectively[1]. FNHs generally demonstrate avid arterial phase postcontrast enhancement on both CT and MRI, and they tend to blend in with adjacent normal liver on delayed imaging (Fig. 2)[1]. When using an MRI hepatobiliary contrast agent (e.g., Eovist; gadoxetate disodium; Bayer HealthCare, Wayne, NJ), FNHs are usually isointense or hyperintense to adjacent liver 10–20 min after contrast material injection (hepatobiliary phase) due to contrast material retention[3,4]. However, use of such contrast material is currently an off-label practice in the pediatric population. FNHs also frequently have a central scar that is hyperintense on T2-weighted MRI and may demonstrate delayed enhancement on both CT and MRI (Figs. 2 and 3)[1]. Early opacification of adjacent hepatic venous structures suggests lesional arteriovenous shunting of blood flow (Fig. 3).Figure 3


Imaging of multifocal liver lesions in children and adolescents.

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

A 13-year-old boy with incidentally detected large FNH. Late arterial phase postcontrast CT image shows a large hyperenhancing lesion within the posterior segment of the right hepatic lobe that has lobular circumscribed margins. The mass has a prominent hypoattenuating central scar that contains several small, tortuous, hepatic artery branches (arrowhead). Early opacification of the right hepatic vein (arrow) is due to arteriovenous shunting of blood. A second smaller arterially hyperenhancing lesion is not shown.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569672&req=5

Figure 3: A 13-year-old boy with incidentally detected large FNH. Late arterial phase postcontrast CT image shows a large hyperenhancing lesion within the posterior segment of the right hepatic lobe that has lobular circumscribed margins. The mass has a prominent hypoattenuating central scar that contains several small, tortuous, hepatic artery branches (arrowhead). Early opacification of the right hepatic vein (arrow) is due to arteriovenous shunting of blood. A second smaller arterially hyperenhancing lesion is not shown.
Mentions: At ultrasonography, FNHs are circumscribed, exert a local mass effect, and may appear hypoechoic, isoechoic, or hyperechoic[1]. On computed tomography (CT) and magnetic resonance imaging (MRI), FNHs appear as discrete lesions with circumscribed lobular margins (Figs. 1–3). On non-contrast CT, these lesions are isoattenuating/slightly hypoattenuating to normal liver, whereas they are typically mildly hypointense/isointense and mildly hyperintense/isointense on non-contrast T1-weighted and T2-weighted MRI, respectively[1]. FNHs generally demonstrate avid arterial phase postcontrast enhancement on both CT and MRI, and they tend to blend in with adjacent normal liver on delayed imaging (Fig. 2)[1]. When using an MRI hepatobiliary contrast agent (e.g., Eovist; gadoxetate disodium; Bayer HealthCare, Wayne, NJ), FNHs are usually isointense or hyperintense to adjacent liver 10–20 min after contrast material injection (hepatobiliary phase) due to contrast material retention[3,4]. However, use of such contrast material is currently an off-label practice in the pediatric population. FNHs also frequently have a central scar that is hyperintense on T2-weighted MRI and may demonstrate delayed enhancement on both CT and MRI (Figs. 2 and 3)[1]. Early opacification of adjacent hepatic venous structures suggests lesional arteriovenous shunting of blood flow (Fig. 3).Figure 3

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