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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 1-year-old boy with increasing abdominal distention due to multifocal hepatoblastoma. (a,b) Axial and coronal reformatted postcontrast CT images show a large, heterogeneous, predominantly low attenuation mass replacing much of the liver. The liver is also enlarged. A few satellite lesions (arrows) are present within the right hepatic lobe, and areas of focal ossification (histopathologically proven) are present within the left hepatic lobe lateral segment (arrowheads).
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Figure 9: A 1-year-old boy with increasing abdominal distention due to multifocal hepatoblastoma. (a,b) Axial and coronal reformatted postcontrast CT images show a large, heterogeneous, predominantly low attenuation mass replacing much of the liver. The liver is also enlarged. A few satellite lesions (arrows) are present within the right hepatic lobe, and areas of focal ossification (histopathologically proven) are present within the left hepatic lobe lateral segment (arrowheads).

Mentions: On imaging, hepatoblastomas present as variably sized, circumscribed, lobular lesions that have the potential to replace most of the liver and cause substantial hepatomegaly. The echogenicity and echotexture of these tumors on ultrasonography is variable, and areas of internal focally increased echogenicity with posterior acoustic shadowing suggest the presence of calcification (or bone)[17]. On CT, hepatoblastomas are typically predominantly low attenuation, although areas of hyperenhancement may be present (especially along the periphery and septations)[17,21]. Discrete chunky calcifications (or osseous foci) may be noted (Fig. 9)[21]. These tumors can appear homogeneous or heterogeneous on MRI, although they are predominantly T2-weighted hyperintense and T1-weighted hypointense[17]. Portal and hepatic venous structures should be assessed for tumor thrombus, and upper abdominal lymph nodes should also be evaluated for potential metastatic spread. Delayed phase postcontrast MRI using a hepatobiliary contrast agent has recently been shown to be beneficial for demonstrating the relationship of the tumor with the portal and hepatic veins and for identifying intrahepatic satellite lesions, both factors that directly affect clinical management[22].Figure 9


Imaging of multifocal liver lesions in children and adolescents.

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

A 1-year-old boy with increasing abdominal distention due to multifocal hepatoblastoma. (a,b) Axial and coronal reformatted postcontrast CT images show a large, heterogeneous, predominantly low attenuation mass replacing much of the liver. The liver is also enlarged. A few satellite lesions (arrows) are present within the right hepatic lobe, and areas of focal ossification (histopathologically proven) are present within the left hepatic lobe lateral segment (arrowheads).
© Copyright Policy
Related In: Results  -  Collection

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

Figure 9: A 1-year-old boy with increasing abdominal distention due to multifocal hepatoblastoma. (a,b) Axial and coronal reformatted postcontrast CT images show a large, heterogeneous, predominantly low attenuation mass replacing much of the liver. The liver is also enlarged. A few satellite lesions (arrows) are present within the right hepatic lobe, and areas of focal ossification (histopathologically proven) are present within the left hepatic lobe lateral segment (arrowheads).
Mentions: On imaging, hepatoblastomas present as variably sized, circumscribed, lobular lesions that have the potential to replace most of the liver and cause substantial hepatomegaly. The echogenicity and echotexture of these tumors on ultrasonography is variable, and areas of internal focally increased echogenicity with posterior acoustic shadowing suggest the presence of calcification (or bone)[17]. On CT, hepatoblastomas are typically predominantly low attenuation, although areas of hyperenhancement may be present (especially along the periphery and septations)[17,21]. Discrete chunky calcifications (or osseous foci) may be noted (Fig. 9)[21]. These tumors can appear homogeneous or heterogeneous on MRI, although they are predominantly T2-weighted hyperintense and T1-weighted hypointense[17]. Portal and hepatic venous structures should be assessed for tumor thrombus, and upper abdominal lymph nodes should also be evaluated for potential metastatic spread. Delayed phase postcontrast MRI using a hepatobiliary contrast agent has recently been shown to be beneficial for demonstrating the relationship of the tumor with the portal and hepatic veins and for identifying intrahepatic satellite lesions, both factors that directly affect clinical management[22].Figure 9

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