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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 16-year-old boy with recalcitrant peptic ulcer disease due to metastatic gastrinoma (Zollinger–Ellison syndrome). (a) Axial T2-weighted fast spin echo fat-saturated MR image shows numerous hyperintense lesions throughout the liver. (b) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast MR image reveals that many of the liver lesions hyperenhance, consistent with a known history of neuroendocrine tumor. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated delayed phase postcontrast MR image shows that many of the liver lesions demonstrate rapid wash out of contrast material, appearing hypointense to normal liver. Gastric fold thickening (arrowheads) is due to hypergastrinemia.
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Figure 18: A 16-year-old boy with recalcitrant peptic ulcer disease due to metastatic gastrinoma (Zollinger–Ellison syndrome). (a) Axial T2-weighted fast spin echo fat-saturated MR image shows numerous hyperintense lesions throughout the liver. (b) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast MR image reveals that many of the liver lesions hyperenhance, consistent with a known history of neuroendocrine tumor. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated delayed phase postcontrast MR image shows that many of the liver lesions demonstrate rapid wash out of contrast material, appearing hypointense to normal liver. Gastric fold thickening (arrowheads) is due to hypergastrinemia.

Mentions: Numerous pediatric neoplasms metastasize to the liver, typically via a hematogeneous route. Hepatic metastases are usually multiple and readily visible on ultrasonography, contrast-enhanced CT, and MRI. Based on the particular imaging features of hepatic metastases, the most likely primary neoplasm can sometimes be suggested. On postcontrast CT and MRI, hepatic metastases may be hypoenhancing (due to relative hypovascularity compared with adjacent normal liver) (Figs. 15–17) or hyperenhancing (due to relative hypervascularity compared with adjacent normal liver) (Figs. 18 and 19). The presence of multiple liver lesions containing fluid-fluid levels and an adrenal mass can be seen in the setting of metastatic neuroblastoma (Fig. 15)[36,37]. MRI using a hepatobiliary contrast agent may prove useful for evaluating the possibility of hepatic metastatic disease in the setting of multifocal liver lesions, as metastases typically hypoenhance on delayed imaging due to lack of contrast material retention[4].Figure 15


Imaging of multifocal liver lesions in children and adolescents.

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

A 16-year-old boy with recalcitrant peptic ulcer disease due to metastatic gastrinoma (Zollinger–Ellison syndrome). (a) Axial T2-weighted fast spin echo fat-saturated MR image shows numerous hyperintense lesions throughout the liver. (b) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast MR image reveals that many of the liver lesions hyperenhance, consistent with a known history of neuroendocrine tumor. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated delayed phase postcontrast MR image shows that many of the liver lesions demonstrate rapid wash out of contrast material, appearing hypointense to normal liver. Gastric fold thickening (arrowheads) is due to hypergastrinemia.
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Related In: Results  -  Collection

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

Figure 18: A 16-year-old boy with recalcitrant peptic ulcer disease due to metastatic gastrinoma (Zollinger–Ellison syndrome). (a) Axial T2-weighted fast spin echo fat-saturated MR image shows numerous hyperintense lesions throughout the liver. (b) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated arterial phase postcontrast MR image reveals that many of the liver lesions hyperenhance, consistent with a known history of neuroendocrine tumor. (c) Axial T1-weighted three-dimensional spoiled gradient recalled fat-saturated delayed phase postcontrast MR image shows that many of the liver lesions demonstrate rapid wash out of contrast material, appearing hypointense to normal liver. Gastric fold thickening (arrowheads) is due to hypergastrinemia.
Mentions: Numerous pediatric neoplasms metastasize to the liver, typically via a hematogeneous route. Hepatic metastases are usually multiple and readily visible on ultrasonography, contrast-enhanced CT, and MRI. Based on the particular imaging features of hepatic metastases, the most likely primary neoplasm can sometimes be suggested. On postcontrast CT and MRI, hepatic metastases may be hypoenhancing (due to relative hypovascularity compared with adjacent normal liver) (Figs. 15–17) or hyperenhancing (due to relative hypervascularity compared with adjacent normal liver) (Figs. 18 and 19). The presence of multiple liver lesions containing fluid-fluid levels and an adrenal mass can be seen in the setting of metastatic neuroblastoma (Fig. 15)[36,37]. MRI using a hepatobiliary contrast agent may prove useful for evaluating the possibility of hepatic metastatic disease in the setting of multifocal liver lesions, as metastases typically hypoenhance on delayed imaging due to lack of contrast material retention[4].Figure 15

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