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Ro E, Schooler GR, Morin CE, Khanna G, Towbin AJ. Update on the imaging evaluation of pediatric liver tumors from the ACR Pediatric LI-RADS Working Group. Abdom Radiol (NY) 2024:10.1007/s00261-024-04565-5. [PMID: 39292279 DOI: 10.1007/s00261-024-04565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Esther Ro
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
- Northwestern University Feinberg School of Medicine, Chicago, USA.
| | - Gary R Schooler
- Cincinnati Children's Hospital, Cincinnati, USA
- University of Cincinnati College of Medicine, Cincinnati, USA
| | - Cara E Morin
- Cincinnati Children's Hospital, Cincinnati, USA
- University of Cincinnati College of Medicine, Cincinnati, USA
| | - Geetika Khanna
- Emory University and Children's Healthcare of Atlanta, Atlanta, USA
| | - Alexander J Towbin
- Cincinnati Children's Hospital, Cincinnati, USA
- University of Cincinnati College of Medicine, Cincinnati, USA
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Hwang SM, Yoo SY, Jeong WK, Lee MW, Jeon TY, Kim JH. Superb Microvascular Imaging in Pediatric Focal Nodular Hyperplasia. J Pediatr Hematol Oncol 2024; 46:e233-e240. [PMID: 38408130 PMCID: PMC10956684 DOI: 10.1097/mph.0000000000002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To investigate superb microvascular imaging (SMI), a novel Doppler ultrasound technique that can visualize low-velocity microvascular flow, for assessing pediatric focal nodular hyperplasia (FNH). PATIENTS AND METHODS Nine FNH lesions in 6 patients were enrolled. On SMI and color Doppler imaging (CDI), intralesional vascularity was assessed visually and categorized as typical spoke-wheel pattern (central vessel radiating from the center to the periphery), multifocal spoke-wheel pattern, and nonspecific pattern. We compared the vascular features of the lesions between SMI and CDI and evaluated vascular patterns according to lesion size. RESULTS In terms of vascularity pattern, the typical spoke-wheel pattern of FNH was noted more frequently on SMI (67%) than on CDI (11%; P < 0.05). In addition, a multifocal spoke-wheel pattern was noted in all remaining lesions (33%) on SMI. On the contrary, a nonspecific vascular pattern was detected in the majority (78%) of CDI. Regarding the lesion size and vascularity on SMI, the typical spoke-wheel pattern was seen more frequently in the small FNH group than in the large FNH group. The intralesional vascular signal was detected more frequently on SMI (100%) than on CDI (89%). CONCLUSION SMI is feasible in evaluating FNH in children and has a greater ability to demonstrate the spoke-wheel pattern than CDI.
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Affiliation(s)
- Sook Min Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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Tsalikidis C, Mitsala A, Pappas-Gogos G, Romanidis K, Tsaroucha AK, Pitiakoudis M. Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out? J Clin Med 2023; 12:6034. [PMID: 37762973 PMCID: PMC10532121 DOI: 10.3390/jcm12186034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes.
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Affiliation(s)
- Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - George Pappas-Gogos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Konstantinos Romanidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Alexandra K. Tsaroucha
- Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
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Morin CE, Kolbe AB, Alazraki A, Chavhan GB, Gill A, Infante J, Khanna G, Nguyen HN, O'Neill AF, Rees MA, Sharma A, Squires JE, Squires JH, Syed AB, Tang ER, Towbin AJ, Schooler GR. Cancer Therapy-related Hepatic Injury in Children: Imaging Review from the Pediatric LI-RADS Working Group. Radiographics 2023; 43:e230007. [PMID: 37616168 DOI: 10.1148/rg.230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The liver is the primary organ for the metabolism of many chemotherapeutic agents. Treatment-induced liver injury is common in children undergoing cancer therapy. Hepatic injury occurs due to various mechanisms, including biochemical cytotoxicity, hepatic vascular injury, radiation-induced cytotoxicity, and direct hepatic injury through minimally invasive and invasive surgical treatments. Treatment-induced liver injury can be seen contemporaneous with therapy and months to years after therapy is complete. Patients can develop a combination of hepatic injuries manifesting during and after treatment. Acute toxic effects of cancer therapy in children include hepatitis, steatosis, steatohepatitis, cholestasis, hemosiderosis, and vascular injury. Longer-term effects of cancer therapy include hepatic fibrosis, chronic liver failure, and development of focal liver lesions. Quantitative imaging techniques can provide useful metrics for disease diagnosis and monitoring, especially in treatment-related diffuse liver injury such as hepatic steatosis and steatohepatitis, hepatic iron deposition, and hepatic fibrosis. Focal liver lesions, including those developing as a result of treatment-related vascular injury such as focal nodular hyperplasia-like lesions and hepatic perfusion anomalies, as well as hepatic infections occurring as a consequence of immune suppression, can be anxiety provoking and confused with recurrent malignancy or hepatic metastases, although there often are imaging features that help elucidate the correct diagnosis. Radiologic evaluation, in conjunction with clinical and biochemical screening, is integral to diagnosing and monitoring hepatic complications of cancer therapy in pediatric patients during therapy and after therapy completion for long-term surveillance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material See the invited commentary by Ferraciolli and Gee in this issue.
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Affiliation(s)
- Cara E Morin
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Amy B Kolbe
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Adina Alazraki
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Govind B Chavhan
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Annie Gill
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Juan Infante
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Geetika Khanna
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - HaiThuy N Nguyen
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Allison F O'Neill
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Mitchell A Rees
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Akshay Sharma
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - James E Squires
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Judy H Squires
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Ali B Syed
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Elizabeth R Tang
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Gary R Schooler
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
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5
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Diagnosis and Follow-up of Incidental Liver Lesions in Children. J Pediatr Gastroenterol Nutr 2022; 74:320-327. [PMID: 34984985 DOI: 10.1097/mpg.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow-up of incidental liver lesions based on review of the literature, use of state-of-the-art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions, have specific imaging characteristics. Recently, contrast-enhanced ultrasound (CEUS) was Food and Drug Administration (FDA)-approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and alpha fetoprotein (AFP) should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and whenever biopsy is not feasible.
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6
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Yu X, Chang J, Zhang D, Lu Q, Wu S, Li K. Ultrasound-Guided Percutaneous Thermal Ablation of Hepatic Focal Nodular Hyperplasia--A Multicenter Retrospective Study. Front Bioeng Biotechnol 2022; 9:826926. [PMID: 35071222 PMCID: PMC8770748 DOI: 10.3389/fbioe.2021.826926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Aim: To evaluate the clinical effect of ultrasound (US)-guided percutaneous thermal ablation of hepatic focal nodular hyperplasia (FNH). Methods: A retrospective analysis of the clinical data of patients undergoing US-guided percutaneous thermal ablation of FNH from November 2008 to August 2021 at five medical centers in China was conducted. Results: A total of 53 patients were included (26 males and 27 females). The mean age was 35.1 ± 10.8 years. Sixty-five lesions (46 solitary cases and 7 cases with multiple lesions) were included, 70.8% (46/65) of which were located in the right liver lobe. The mean tumor length was 2.9 ± 1.5 cm. All patients successfully completed the ablation treatment. Immediate postoperative imaging showed that the primary technical success rate was 94.3% (50/53). Two patients underwent ablation 3 and 6 months after the primary ablation, and the secondary technical success rate was 100% (2/2). The incidence of complications was 3.8% (2/53). Imaging follow-up was conducted regularly after ablation, and no residual lesion enlargement or tumor recurrence was observed during the follow-up period. The technique efficacy rate was 98.1% (52/53). Conclusion: US-guided percutaneous thermal ablation is a safe and effective treatment for FNH of the liver.
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Affiliation(s)
- Xuan Yu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Jiandong Chang
- Department of Ultrasound, Xiamen Chinese Medical Hospital, Fujian, China
| | - Dezhi Zhang
- Department of Ultrasound, The First Hospital of Jilin University, Jilin, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital, Sichuan, China
| | - Songsong Wu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian, China
| | - Kai Li
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong, China
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7
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Mochizuki M, Nakayama Y, Sato K, Inukai T. Focal nodular hyperplasia-like lesion in a girl with obesity and fatty liver. Pediatr Int 2022; 64:e15392. [PMID: 36270924 PMCID: PMC10107613 DOI: 10.1111/ped.15392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Mie Mochizuki
- Department of Pediatrics, Kyonan Medical Center Fujikawa Hospital, Yamanashi, Japan.,Department of Pediatrics, University of Yamanashi, Yamanashi, Japan.,Department of Pediatrics, National Hospital Organization, Kofu Hospital, Yamanashi, Japan
| | - Yasuhiro Nakayama
- Department of Internal Medicine, Kyonan Medical Center Fujikawa Hospital, Yamanashi, Japan
| | - Kazumasa Sato
- Department of Pediatrics, Kyonan Medical Center Fujikawa Hospital, Yamanashi, Japan.,Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Takeshi Inukai
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
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8
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Özcan HN, Karçaaltıncaba M, Seber T, Yalçın B, Oğuz B, Akyüz C, Haliloğlu M. Hepatocyte-specific contrast-enhanced MRI findings of focal nodular hyperplasia-like nodules in the liver following chemotherapy in pediatric cancer patients. ACTA ACUST UNITED AC 2021; 26:370-376. [PMID: 32490830 DOI: 10.5152/dir.2019.19398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE We aimed to assess the MRI findings and follow-up of multiple focal nodular hyperplasia (FNH)- like lesions in pediatric cancer patients diagnosed by imaging findings. METHODS We retrospectively analyzed clinical data and MRI examinations of 16 pediatric patients, who had been scanned using gadoxetate disodium (n=13) and gadobenate dimeglumine (n=3). Hepatic nodules were reviewed according to their number, size, contour, T1- and T2-weighted signal intensities, arterial, portal, delayed and hepatobiliary phase enhancement patterns. Follow-up images were evaluated for nodule size, number, and appearance. RESULTS All 16 patients received chemotherapy in due course. Time interval between the initial diagnosis of cancer and detection of the hepatic nodule was 2-14 years. Three patients had a single lesion, 13 patients had multiple nodules. The median size of the largest nodules was 19.5 mm (range, 8-41 mm). Among 16 patients that received hepatocyte-specific agents, FNH-like nodules appeared hyperintense in 11 and isointense in 5 on the hepatobiliary phase. During follow-up, increased number and size of the nodules were seen in 4 patients. The nodules showed growth between 6-15 mm. CONCLUSION Liver MRI using hepatocyte-specific agents is a significant imaging method for the diagnosis of FNH-like lesions, which can occur in a variety of diseases. Lesions can increase in size and number in pediatric patients.
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Affiliation(s)
- H Nursun Özcan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Turgut Seber
- Department of Radiology, Kayseri City Hospital, Kayseri, Turkey
| | - Bilgehan Yalçın
- Department of Pediatrics, Division of Pediatric Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oğuz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Canan Akyüz
- Department of Pediatrics, Division of Pediatric Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloğlu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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9
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Abstract
The most recent advance in the care of children diagnosed with hepatoblastoma and hepatocellular carcinoma is the Pediatric Hepatic International Tumor Trial, which opened to international enrollment in 2018. It is being conducted as a collaborative effort by the pediatric multicenter trial groups in North America, Europe, and the Far East. This international effort was catalyzed by a new unified global risk stratification system for hepatoblastoma, an international histopathologic consensus classification for pediatric liver tumors, and a revised 2017 collaborative update of the PRE-Treatment EXTent of disease radiographic based staging system.
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Affiliation(s)
- Rebecka Meyers
- Division Pediatric Surgery, University of Utah, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113, USA.
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima 734-8551, Japan
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Greg M Tiao
- Division Pediatric Surgery, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229, USA
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10
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Yao Z, Zeng Q, Yu X, Lin S, Jiang S, Ma D, Li K. Case Report: Ultrasound-Guided Percutaneous Microwave Ablation of Focal Nodular Hyperplasia in a 9-Year-Old Girl. Front Pediatr 2021; 9:710779. [PMID: 34368033 PMCID: PMC8337056 DOI: 10.3389/fped.2021.710779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is a rare benign tumor-like space-occupying lesion of the liver that is especially rare in children. Since there have been no reports of malignant progression of this disease and these lesions remain unchanged for a long period of time or even disappear in some cases, it remains controversial whether clinical treatment is needed. However, if the diagnosis is unclear, the patient has symptoms or the lesion becomes enlarged during follow-up, clinical treatment should be considered. Here, we report the first case of FNH near the gallbladder treated by ultrasound-guided percutaneous microwave ablation (MWA) in a 9-year-old girl.
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Affiliation(s)
| | - Qingjing Zeng
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuan Yu
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shulian Lin
- Dongguan Children's Hospital, Dongguan, China
| | | | - Da Ma
- Dongguan Children's Hospital, Dongguan, China
| | - Kai Li
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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11
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Zarfati A, Chambers G, Pio L, Guerin F, Fouquet V, Franchi-Abella S, Branchereau S. Management of focal nodular hyperplasia of the liver: Experience of 50 pediatric patients in a tertiary center. J Pediatr Surg 2020; 55:1885-1891. [PMID: 32057440 DOI: 10.1016/j.jpedsurg.2020.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/13/2019] [Accepted: 01/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a rare benign hepatic lesion in children. No management guidelines for pediatric population exist because of limited evidence. OBJECTIVE To review the experience of a large tertiary liver center, providing additional clinical data to help formulate management guidelines for FNH in the pediatric population. METHODS We analyzed data of children <18 years diagnosed with FNH from 1996 to 2018 at our hospital, detailing management and long-term clinical outcome. RESULTS 50 patients were identified. The median age was 10 years old (range 0.75-15.5 years old). The mean diameter of FNH was 5.9 cm (±3.1 cm). 10 patients had multiple lesions. First-line management: watchful waiting with serial checks (n = 37), surgery (n = 13). Of the watchful waiting patients, 10 required eventual second-line surgery. After a median follow-up of 4.7 years (range 0.5-20 years), 46 patients were asymptomatic, with no significant difference in clinical outcome (p = 0.962) between the two first-line management approaches. Lesions demonstrated growth in 13 cases: 5 of these required second-line surgery. In these patients, there was no significant difference in clinical outcome (p = 0.188) compared to nonoperative patients. Considering all surgically treated patients, there was no significant difference between first-line and second-line surgery for clinical outcome (p = 0.846), hospital stay (p = 0.410), complications (p = 0.510) and severe complications (p = 0.385). CONCLUSIONS Our data support the hypothesis that watchful waiting is a safe initial approach to pediatric FNH management in patients with no major symptoms or complications. Surgery should be reserved for patients with diagnostic doubt, persistent symptoms and/or biological or significant anatomical abnormalities. FNH growth alone should not be considered as an indication for surgery. TYPE OF STUDY Therapeutic study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Angelo Zarfati
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Greg Chambers
- Department of Pediatric Radiology, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Luca Pio
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Florent Guerin
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Virginie Fouquet
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Stéphanie Franchi-Abella
- Department of Pediatric Radiology, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Sophie Branchereau
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
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12
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Abstract
Benign liver tumors in children are far less frequent than their malignant counterparts. Recently, there have been advances of diagnostic procedures and novel treatments with improved classification as a result. While malignant pediatric liver tumors have been comprehensively addressed by multicenter international tumor trials, benign tumors have more usually relied upon individualised workup and treatment. Due to the rarity and heterogeneity of these different entities, large studies are lacking. In this article the authors highlight the spectrum of benign liver tumors with special focus on specific clinical features, pathology, and treatment.
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Affiliation(s)
- J Fuchs
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany.
| | - S W Warmann
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany
| | - C Urla
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany
| | - J F Schäfer
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
| | - A Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany
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13
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Hepatobiliary MRI Contrast Agents: Pattern Recognition Approach to Pediatric Focal Hepatic Lesions. AJR Am J Roentgenol 2020; 214:976-986. [DOI: 10.2214/ajr.19.22239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Cattoni A, Rovelli A, Prunotto G, Bonanomi S, Invernizzi P, Perego R, Mariani AM, Balduzzi A. Hepatic focal nodular hyperplasia after pediatric hematopoietic stem cell transplantation: The impact of hormonal replacement therapy and iron overload. Pediatr Blood Cancer 2020; 67:e28137. [PMID: 31889398 DOI: 10.1002/pbc.28137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The advent of techniques for the assessment of iron overload (liver T2*-MRI) has led to the awareness that focal nodular hyperplasia (FNH) represents a possible incidental finding after hematopoietic stem cell transplantation (HSCT), though its pathogenesis is still unclear. METHODS We performed a retrospective analysis of the liver T2*-MRI scans performed between 2013 and 2018 in a single pediatric HSCT Unit and recorded the number of patients with FNH (group A). Patients incidentally diagnosed with FNH at imaging performed for different clinical indications were included in group B. RESULTS Nine of 105 (8.6%) patients from group A were diagnosed with FNH. Group B included three patients. Overall, 12 patients were diagnosed 4.4 ± 3.1 years after HSCT. At univariate analysis, female gender (odds ratio [OR] 3.77, P = .03), moderate-to-severe iron overload (OR 6.97, P = .01), and hormone replacement therapy (HRT) administered for at least 6 months (OR 18.20, P = .0002) exposed patients to a higher risk of developing FNH. The detrimental effect of HRT was significant also at multivariate analysis (OR 7.93, P = .024). MRI-T2* values in affected patients were statistically lower than healthy controls (P < .001). CONCLUSIONS We confirm the high incidence of FNH among transplanted pediatric patients and demonstrate the potential pathogenic role of HRT and iron overload.
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Affiliation(s)
- Alessandro Cattoni
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Attilio Rovelli
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Giulia Prunotto
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Sonia Bonanomi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Pietro Invernizzi
- Gastroenterologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Rosangela Perego
- Radiologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Anna Maria Mariani
- Radiologia, Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Adriana Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
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15
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Akhaladze D, Grachev N, Kachanov D, Talypov S, Merkulov N, Uskova N, Andreev E, Rabaev G, Ivanova N, Varfolomeeva S. Liver resection for atypical giant focal nodular hyperplasia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability. Pediatr Radiol 2019; 49:82-90. [PMID: 30267165 DOI: 10.1007/s00247-018-4250-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/20/2018] [Accepted: 08/29/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Focal nodular hyperplasia and hepatic adenoma are rare liver tumors in which specific features on contrast-enhanced ultrasound (US) have been reported but are little known in children. OBJECTIVE To assess the interobserver agreement in diagnosing and differentiating focal nodular hyperplasia and hepatic adenoma in children using established adult contrast-enhanced US characteristics. MATERIALS AND METHODS Thirty children with a definite or probable diagnosis of focal nodular hyperplasia or hepatic adenoma on magnetic resonance imaging (MRI)/histology who underwent contrast-enhanced US studies were included. Typical and additional contrast-enhanced US features of focal nodular hyperplasia and hepatic adenoma were included. The lesions were classified as definite/probable focal nodular hyperplasia, definite/probably hepatic adenoma or unclassified. The interobserver kappa of contrast-enhanced US characteristics was calculated. RESULTS Focal nodular hyperplasia and hepatic adenoma in children demonstrate contrast-enhanced US characteristics similar to those in adults. Among the nine lesions with confirmed histological diagnosis, correct diagnosis was made in 7 (77.8%) based on contrast-enhanced US criteria. Two lesions were unclassified by both observers due to a mixed arterial filling pattern. Interobserver kappa for contrast-enhanced US diagnosis was 0.64 (P<0.0001). CONCLUSION There is a good interobserver kappa for separating focal nodular hyperplasia from hepatic adenoma in children using established adult contrast-enhanced US features.
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17
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Masand PM. Magnetic resonance imaging features of common focal liver lesions in children. Pediatr Radiol 2018; 48:1234-1244. [PMID: 30078045 DOI: 10.1007/s00247-018-4218-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022]
Abstract
Magnetic resonance imaging (MRI) is commonly used to characterize focal liver masses in the pediatric population. MRI is the preferred modality because of its superior contrast resolution and utility for obtaining functional sequences such as diffusion-weighted imaging (DWI). MR exams performed with a hepatocyte-specific gadolinium-based contrast agent can characterize focal liver lesions, which helps in differentiating a common benign entity such as focal nodular hyperplasia from other liver pathology when the background liver is normal. The most common benign focal lesion is a hemangioma, and metastases followed by hepatoblastoma are the most common malignant lesions. This article can help radiologists become familiar with the pre- and post-contrast imaging features of common pediatric liver masses.
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Affiliation(s)
- Prakash M Masand
- Cardiovascular Imaging, Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA. .,Baylor College of Medicine, Houston, TX, USA.
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18
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19
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Shelmerdine SC, Chavhan GB, Babyn PS, Nathan PC, Kaste SC. Imaging of late complications of cancer therapy in children. Pediatr Radiol 2017; 47:254-266. [PMID: 27904916 DOI: 10.1007/s00247-016-3708-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/25/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022]
Abstract
Long-term survival after childhood cancer has improved dramatically over recent decades but survivors face lifelong risks of adverse health effects. Many of these chronic conditions are a direct result of previous therapeutic exposures. Compared to their siblings, survivors face a greater than 8-fold increase in relative risk of severe or life-threatening medical conditions; the most significant of these include second malignancies and cardiovascular and pulmonary diseases. Imaging can play a key role in identifying and characterizing such complications, which can be reasonably predicted with knowledge of the child's treatment. This article highlights the varied radiologic presentations and features seen in late cancer-therapy-related conditions.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Paul S Babyn
- Department of Medical Imaging, Royal University Hospital, Saskatoon, SK, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Sue C Kaste
- Department of Diagnostic Imaging and Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Radiology, University of Tennessee School of Health Sciences, Memphis, Memphis, TN, USA
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Chavhan GB, Shelmerdine S, Jhaveri K, Babyn PS. Liver MR Imaging in Children: Current Concepts and Technique. Radiographics 2016; 36:1517-32. [DOI: 10.1148/rg.2016160017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a benign hepatic lesion that is rare in children. The aim of the present study was to review the clinical features of children with FNH and our institution's experience in the management of this rare disease. METHODS A review of the medical records of children diagnosed as having FNH between 1999 and 2013 at West China Hospital of Sichuan University was undertaken. RESULTS Seventy-nine patients with FNH were identified: 68 patients without a history of malignancy and 11 patients with a history of malignancy. Thirty-seven (46.8%) patients were symptomatic at presentation. Patients with a history of malignancy had smaller FNH lesions and were less likely to have a central scar in FNH than do patients without a history of malignancy. Forty-seven patients underwent liver resection because of concern for malignancy, symptoms, and/or large lesions. Three patients were treated by embolization because of compression of the adjacent organs. There was no operative death or severe postoperative complications. Fourteen patients underwent liver biopsy to rule out malignant masses. The remaining 15 patients were managed expectantly with imaging surveillance. On follow-up, 2 patients for whom observation was initially recommended eventually required resection because of a mass effect. CONCLUSIONS The clinical features of pediatric FNH are variable and can be nonspecific. Our data emphasize the therapeutic approach that active management is indicated in symptomatic or progressive FNH and in children with diagnostic difficulties, whereas observation management is recommended in asymptomatic children with a definitive diagnosis.
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Pugmire BS, Towbin AJ. Magnetic resonance imaging of primary pediatric liver tumors. Pediatr Radiol 2016; 46:764-77. [PMID: 27229495 DOI: 10.1007/s00247-016-3612-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/28/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
Although primary hepatic neoplasms are less common than other intra-abdominal tumors in children, these neoplasms are a significant source of morbidity and mortality in the pediatric population. MRI is increasingly relied upon in the diagnostic evaluation of these lesions, both before and after treatment, and familiarity with the MRI findings associated with these neoplasms is a must for pediatric radiologists. Advances in MRI technology, particularly the advent of hepatocyte-specific gadolinium-based MRI contrast agents, have allowed for accurate characterization of several types of hepatic neoplasms on the basis of imaging appearance. In this review, we provide an overview of the approach to imaging hepatic neoplasms in children using MRI, including a sample imaging protocol. We also discuss the relevant clinical features and MRI findings of the most clinically relevant entities, including their appearance on post-contrast imaging using hepatocyte-specific gadolinium-based MRI contrast agents.
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Affiliation(s)
- Brian S Pugmire
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA.
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Smith EA, Dillman JR. Current role of body MRI in pediatric oncology. Pediatr Radiol 2016; 46:873-80. [PMID: 27229504 DOI: 10.1007/s00247-016-3560-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/06/2015] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
Magnetic resonance imaging (MRI) plays an important role in the imaging of children with non-central nervous system malignancies, and it is increasingly replacing or complementing CT in many cases. MRI has several advantages over CT, including superior contrast resolution as well as superior tissue characterization with the use of novel pulse sequences and functional or organ-specific contrast agents. In addition, the lack of ionizing radiation - an important consideration in children - allows for multiphase dynamic post-contrast imaging, which can be useful for lesion detection and characterization. Several challenges remain in the performance of MRI in pediatric oncology patients, including the frequent need for sedation or anesthesia in young children because of long imaging times, as well as the suboptimal imaging of the lungs in the evaluation for pulmonary metastatic disease. However, despite these challenges, with continued improvements in MRI image quality and the development of novel sequences, contrast agents and quantitative imaging techniques, MRI is expected to play an ever increasing role in the imaging of pediatric oncology patients.
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Affiliation(s)
- Ethan A Smith
- Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4252, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Almotairi M, Oudjhane K, Chavhan GB. Pediatric multifocal liver lesions evaluated by MRI. Indian J Radiol Imaging 2015; 25:296-302. [PMID: 26288526 PMCID: PMC4531456 DOI: 10.4103/0971-3026.161466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective: The purpose of this study is to present our experience with MRI evaluation of multifocal liver lesions in children and describe the MRI characteristics of these lesions. Patients and Methods: A retrospective review of consecutive MRI exams performed for the evaluation of multiple liver lesions between 1 January 2007 and 31 December 2012 was done to note the number of lesions, the size of the largest lesion, MR signal characteristics, and background liver. Final diagnosis was assigned to each case based on pathology in the available cases and a combination of clinical features, imaging features, and follow-up in the remaining cases. Results: A total of 48 children (22 boys, 26 girls; age between 3 months and 18 years with average age 10.58 years and median age 11 years) were included in the study. Totally 51 lesion diagnoses were seen in 48 children that included 17 focal nodular hyperplasia (FNH), 8 hemangiomas, 7 metastases, 6 regenerative nodules, 3 adenomas, 3 abscesses, and one each of angiomyolipoma, epithelioid hemangioendothelioma, focal fatty infiltration, hepatocellular carcinoma, hepatic infarction, nodular regenerative hyperplasia, and hepatic cyst. Background liver was normal in 33, cirrhotic in 10, fatty in 3, and siderotic in 2 children. Most FNH, hemangiomas, and regenerative nodules showed characteristic MRI features, while metastases were variable in signal pattern. Conclusion: Many commonly seen multifocal liver lesions in children have characteristic MRI features. MRI can help to arrive at reasonable differential diagnoses for multifocal liver lesions in children and guide further investigation and management.
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Affiliation(s)
- Majed Almotairi
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kamaldine Oudjhane
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Chiorean L, Cui XW, Tannapfel A, Franke D, Stenzel M, Kosiak W, Schreiber-Dietrich D, Jüngert J, Chang JM, Dietrich CF. Benign liver tumors in pediatric patients - Review with emphasis on imaging features. World J Gastroenterol 2015; 21:8541-8561. [PMID: 26229397 PMCID: PMC4515836 DOI: 10.3748/wjg.v21.i28.8541] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
Benign hepatic tumors are commonly observed in adults, but rarely reported in children. The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking. Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors. In pediatric patients, most benign focal liver lesions are inborn and may grow like the rest of the body. Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis. Selection of the appropriate imaging test is challenging, since it depends on a number of age-related factors. This paper will discuss the most frequently encountered benign liver tumors in children (infantile hepatic hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and hepatocellular adenoma), as well as a comparison to the current knowledge regarding such tumors in adult patients. The current emphasis is on imaging features, which are helpful not only for the initial diagnosis, but also for pre- and post-treatment evaluation and follow-up. In addition, future perspectives of contrast-enhanced ultrasound (CEUS) in pediatric patients are highlighted, with descriptions of enhancement patterns for each lesion being discussed. The role of advanced imaging tests such as CEUS and magnetic resonance imaging, which allow for non-invasive assessment of liver tumors, is of utmost importance in pediatric patients, especially when repeated imaging tests are needed and radiation exposure should be avoided.
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Alqatie A, Mann E, Moineddin R, Kamath BM, Chavhan GB. Solitary liver lesions in children: interobserver agreement and accuracy of MRI diagnosis. Clin Imaging 2015; 39:442-8. [DOI: 10.1016/j.clinimag.2014.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/27/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022]
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Ma IT, Rojas Y, Masand PM, Castro EC, Himes RW, Kim ES, Goss JA, Nuchtern JG, Finegold MJ, Thompson PA, Vasudevan SA. Focal nodular hyperplasia in children: an institutional experience with review of the literature. J Pediatr Surg 2015; 50:382-7. [PMID: 25746693 DOI: 10.1016/j.jpedsurg.2014.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/13/2014] [Accepted: 06/28/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is uncommonly diagnosed in pediatric patients and may be difficult to distinguish from a malignancy. We present a review of all children with a tissue diagnosis of FNH at our institution, describe the diagnostic modalities, and provide recommendations for diagnosis and follow-up based on our experience and review of the literature. METHODS A retrospective review of children <18years of age diagnosed with FNH at a single institution was performed from 2000 to 2013. RESULTS Twelve patients were identified with a tissue diagnosis of FNH. Two patients required surgical resection of their lesion owing to concern for malignancy. Ten patients were managed expectantly with imaging surveillance after biopsy confirmed a diagnosis of FNH. All patients who underwent MRI had very typical findings including hypointensity on T1 weighted sequences, hyperintensity on T2, and homogenous uptake of contrast on the arterial phase. On follow-up all patients had either a stable lesion or reduction in size. CONCLUSIONS Focal nodular hyperplasia presents typically in children with liver disease, have undergone chemotherapy, and adolescent females. Young children, particularly <5years of age, without underlying liver disease or history of chemotherapy can pose a diagnostic dilemma. In this unique subgroup of children with FNH, MRI and/or needle biopsy should be adequate diagnostic modalities for these lesions.
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Affiliation(s)
- Irene T Ma
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Yesenia Rojas
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Prakash M Masand
- Department of Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eumenia C Castro
- Department of Pathology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Ryan W Himes
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eugene S Kim
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Milton J Finegold
- Department of Pathology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Patrick A Thompson
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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The impact of hepatocyte phase imaging from infancy to young adulthood in patients with a known or suspected liver lesion. Pediatr Radiol 2015; 45:354-65. [PMID: 25246096 DOI: 10.1007/s00247-014-3160-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/21/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Hepatocyte-specific contrast agents are used to help characterize liver lesions. However, there are no studies evaluating the utility of these agents in detecting or diagnosing pediatric liver lesions. The purpose of this study is to assess the impact of the hepatocyte phase of imaging on lesion detection, tumor staging and diagnostic confidence. MATERIALS AND METHODS All patients undergoing an MRI between September 2010 and August 2012 using gadoxetate disodium as the contrast agent were included in this study. Each exam was duplicated so that one copy contained all sequences, including the hepatocyte phase of imaging, and the other copy contained all sequences except the hepatocyte phase of imaging. One reviewer evaluated all exams in a blinded, random fashion. Data tracked included imaging diagnosis, confidence in diagnosis, number of lesions and PRETEXT grade. The imaging diagnosis was compared to histopathology, when available. Data were analyzed for the study population as well as the subset of patients diagnosed with focal nodular hyperplasia (FNH). RESULTS There were 112 patients (56 male; mean age: 9.25 years) included in this study. A total of 33 patients had a malignant tumor and the remainder had either a benign lesion or no lesion. The addition of the hepatocyte phase of imaging significantly improved the diagnostic confidence for all patients (P < 0.0001) as well as specifically for patients diagnosed with FNH (P = 0.003). In nearly a quarter of patients, the hepatocyte phase of imaging allowed the reviewer to detect additional lesions (P = 0.005). In the patients with a malignant tumor, the addition of the hepatocyte phase of imaging changed the PRETEXT grade in 7/30 patients although the results were not significant (P = 0.161). CONCLUSION The addition of the hepatocyte phase of imaging helps to improve lesion detection and increase the diagnostic confidence for all liver tumors, as well as for FNH in particular.
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Gologorsky R, Wong V, Holmes W, Haider A. Liver lesions in children post-oncologic therapy: Review of case reports and institutional observation. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.0302.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gong Y, Chen L, Qiao ZW, Ma YY. Focal nodular hyperplasia coexistent with hepatoblastoma in a 36-d-old infant. World J Gastroenterol 2015; 21:1028-1031. [PMID: 25624742 PMCID: PMC4299321 DOI: 10.3748/wjg.v21.i3.1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/03/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is a benign hepatic tumor characterized by hepatocyte hyperplasia and a central stellate scar. The association of FNH with other hepatic lesions, such as adenomas, hemangiomas and hepatocellular carcinoma, has been previously reported, but FNH associated with another hepatic tumor is rare in infants. Here we report a case of FNH coexistent with hepatoblastoma in a 36-d-old girl. Computed tomography (CT) imaging showed an ill-delineated, inhomogeneous enhanced mass with a central star-like scar in the right lobe of the liver. The tumor showed early mild enhancement at the arterial phase (from 40HU without contrast to 52HU at the arterial phase), intense enhancement at the portal phase (87.7HU) and 98.1HU in the 3-min delay scan. A central scar in the tumor presented as low density on non-contrast CT and slightly enhanced at delayed contrast-enhanced scanning. This infant underwent surgical resection of the tumor. Histopathology demonstrated typical FNH coexistent with a focal hepatoblastoma, which showed epithelioid tumor cells separated by proliferated fibrous tissue.
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Towbin AJ. Pediatric tumours: liver tumours. Cancer Imaging 2014. [PMCID: PMC4242751 DOI: 10.1186/1470-7330-14-s1-o16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chavhan GB, Mann E, Kamath BM, Babyn PS. Gadobenate-dimeglumine-enhanced magnetic resonance imaging for hepatic lesions in children. Pediatr Radiol 2014; 44:1266-74. [PMID: 24771094 DOI: 10.1007/s00247-014-2975-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Magnetic resonance imaging enhanced by hepatocyte-specific contrast media has been found useful to characterize liver lesions in adults and children. OBJECTIVE To present our experience with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for evaluation of focal liver lesions in children. MATERIALS AND METHODS We retrospectively reviewed gadobenate-dimeglumine-enhanced MR images obtained for evaluation of suspected hepatic lesions in 30 children. Signal characteristics on various sequences including 45- to 60-min hepatobiliary phase images were noted by two radiologists. Chart review identified relevant clinical details including history of cancer treatment, available pathology and stability of lesion size on follow-up imaging. RESULTS Of the 30 children who had gadobenate-enhanced MRI, 26 showed focal lesions. Diagnoses in 26 children were focal nodular hyperplasia (FNH) in 15, hemangiomas in 3, regenerating nodules in 3, focal fatty infiltration in 2, indeterminate lesions in 3, and one patient each with adenomas, hepatoblastoma and metastasis. Two patients had multiple diagnoses. All FNH lesions (39), all regenerative nodules (19) and an indeterminate lesion were iso- or hyperintense on hepatobiliary-phase images while all other lesions (28) were hypointense to hepatic parenchyma. The average follow-up period was 21.7 months. CONCLUSION Our experience with gadobenate-enhanced MRI indicates potential utility of gadobenate in the evaluation of pediatric hepatic lesions in differentiating FNH and regenerating nodules from other lesions.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, Canada, M5G 1X8,
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Clinical and Imaging Features of Focal Nodular Hyperplasia in Children. AJR Am J Roentgenol 2014; 202:960-5. [DOI: 10.2214/ajr.13.11856] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Valentino PL, Ling SC, Ng VL, John P, Bonasoni P, Castro DA, Taylor G, Chavhan GB, Kamath BM. The role of diagnostic imaging and liver biopsy in the diagnosis of focal nodular hyperplasia in children. Liver Int 2014; 34:227-34. [PMID: 23829376 DOI: 10.1111/liv.12241] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/04/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Focal nodular hyperplasia (FNH), a benign liver tumour, has a characteristic appearance on diagnostic imaging (DI) and histology. The role of liver biopsy in children for the diagnosis of FNH is unclear. This study investigates the diagnostic accuracy of DI for FNH in children without comorbidities, compared to liver biopsy. METHODS A total of 304 consecutive patients (age <18 years) with a biopsied liver mass were retrospectively ascertained (1990-2010). Individuals with a history of malignancy, liver disease or syndromes with increased malignancy risk were excluded. DI and biopsy data were reviewed. RESULTS After excluding 205 cases, 99 liver masses were studied. Based on histology, the most common diagnosis was hepatoblastoma (46/99, 44%) followed by FNH (23/99, 23%). The mean age at FNH diagnosis was 11.1 ± 5.2 years, with female preponderance (78%), and a median follow-up of 1.35 years (interquartile range 0.54, 4.20 years). 19/23 biopsy-proven FNH met standard criteria for FNH on DI. In 4/23 cases of biopsy-proven FNH, imaging did not suggest FNH. Two false positive cases included adenoma and fibrolamellar hepatocellular carcinoma. On review of original reports, DI had 82.6% sensitivity and 97.4% specificity for the diagnosis of FNH. On blind review, the sensitivity of DI for FNH diagnosis was 81.3% for MRI (13/16), and 53.3% for CT (8/15). CONCLUSIONS In this cohort of children with liver masses and no comorbidities, a diagnosis of FNH by imaging was highly specific, and MRI was the most sensitive study for its diagnosis. Liver biopsy may be deferred in selected children if the DI, particularly MRI, is indicative of FNH.
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Affiliation(s)
- Pamela L Valentino
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Masetti R, Zama D, Gasperini P, Morello W, Prete A, Colecchia A, Festi D, Pession A. Focal nodular hyperplasia of the liver in children after hematopoietic stem cell transplantation. Pediatr Transplant 2013; 17:479-86. [PMID: 23678864 DOI: 10.1111/petr.12091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 12/26/2022]
Abstract
FNH is a non-malignant neoplasia of the liver rarely described in children. A significant percentage of the pediatric cases have been reported in patients with a history of malignant disease treated with chemo-radiation therapy and in children who were given HSCT. Little is known about the pathogenesis of FNH in transplanted children, but many risk factors linked to the HSCT procedure have been hypothesized. The detection of hepatic nodules, particularly in children who underwent HSCT for a previous malignancy, always raises a diagnostic dilemma. To help the physicians in the diagnostic management of this rare entity, we have retrospectively evaluated a series of transplanted children diagnosed with FNH in our Center over the last 15 yr. In this period, we found 10 new diagnoses of FNH. The diagnostic work-up included CEUS, abdominal CT, and MRI. A liver biopsy was performed in two patients. The median FUP time after diagnosing FNH was 3.8 yr, with an abdominal US and no malignant transformation were observed. Possible risk factors and indications for the management of FNH in transplanted children are reported and discussed in a comprehensive review of the literature.
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Affiliation(s)
- Riccardo Masetti
- Paediatric Oncology and Haematology Unit Lalla Seràgnoli, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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Hegde SV, Dillman JR, Lopez MJ, Strouse PJ. Imaging of multifocal liver lesions in children and adolescents. Cancer Imaging 2013; 12:516-29. [PMID: 23400044 PMCID: PMC3569672 DOI: 10.1102/1470-7330.2012.0045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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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Affiliation(s)
- Shilpa V Hegde
- Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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Benign hepatocellular tumors in children: focal nodular hyperplasia and hepatocellular adenoma. Int J Hepatol 2013; 2013:215064. [PMID: 23555058 PMCID: PMC3608344 DOI: 10.1155/2013/215064] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022] Open
Abstract
Benign liver tumors are very rare in children. Most focal nodular hyperplasia (FNH) remain sporadic, but predisposing factors exist, as follows: long-term cancer survivor (with an increasing incidence), portal deprivation in congenital or surgical portosystemic shunt. The aspect is atypical on imaging in two-thirds of cases. Biopsy of the tumor and the nontumoral liver is then required. Surgical resection will be discussed in the case of large tumors with or without symptoms. In the case of associated vascular disorder with portal deprivation, restoration of the portal flow will be discussed in the hope of seeing the involution of FNH. HepatoCellular Adenoma (HCA) is frequently associated with predisposing factors such as GSD type I and III, Fanconi anemia especially if androgen therapy is administered, CPSS, and SPSS. Adenomatosis has been reported in germline mutation of HNF1- α . Management will depend on the presence of a predisposing factor and may include metabolic control, androgen therapy withdrawn, or closure of the shunt when appropriate. Surgery is usually performed on large lesions. In the case of adenomatosis or multiple lesions, surgery will be adapted. Close followup is required in all cases.
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Liu QY, Zhang WD, Lai DM, Ou-yang Y, Gao M, Lin XF. Hepatic focal nodular hyperplasia in children: Imaging features on multi-slice computed tomography. World J Gastroenterol 2012; 18:7048-7055. [PMID: 23323007 PMCID: PMC3531693 DOI: 10.3748/wjg.v18.i47.7048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 09/30/2012] [Accepted: 11/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia (FNH) in children on dynamic contrast-enhanced multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) images.
METHODS: From September 1999 to April 2012, a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University, including 12 cases (5.5%) of FNH in children (age ≤ 18 years old). All the 12 pediatric patients underwent MSCT. We retrospectively analyzed the imaging features of FNH lesions, including the number, location, size, margin, density of FNH demonstrated on pre-contrast and contrast-enhanced computed tomography (CT) scanning, central scar, fibrous septa, pseudocapsule, the morphology of the feeding arteries and the presence of draining vessels (portal vein or hepatic vein).
RESULTS: All the 12 pediatric cases of FNH had solitary lesion. The maximum diameter of the lesions was 4.0-12.9 cm, with an average diameter of 5.5 ± 2.5 cm. The majority of the FNH lesions (10/12, 83.3%) had well-defined margins. Central scar (10/12, 83.3%) and fibrous septa (11/12, 91.7%) were commonly found in children with FNH. Central scar was either isodense (n = 7) or hypodense (n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase. Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases. Pseudocapsule was very rare (1/12, 8.3%) in pediatric FNH. With the exception of central scars and fibrous septa within the lesions, all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images, significantly hyperdense in the arterial phase (12/12, 100.0%), and isodense in the portal venous phase (7/12, 58.3%) and equilibrium phase (11/12, 91.7%). Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH, whereas no neovascularization of malignant tumors was noted. In 9 cases (75.0%), there was a spoke-wheel shaped centrifugal blood supply inside the tumors. The draining hepatic vein was detected in 8 cases of pediatric FNH. However, the draining vessels in the other 4 cases could not be detected. No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.
CONCLUSION: The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH. Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.
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Duigenan S, Anupindi SA, Nimkin K. Imaging of multifocal hepatic lesions in pediatric patients. Pediatr Radiol 2012; 42:1155-68; quiz 1285. [PMID: 22565297 DOI: 10.1007/s00247-012-2400-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/25/2012] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
Imaging plays a vital role in detection and characterization of multifocal liver lesions in children. Numerous causes for these lesions exist, including benign and malignant neoplasms, infectious lesions, and congenital and inflammatory conditions. The imaging spectrum of multifocal liver lesions in children is presented with emphasis on key imaging features, differential diagnoses and helpful relevant clinical features.
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Affiliation(s)
- Shauna Duigenan
- Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA.
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41
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Incidence and etiology of new liver lesions in pediatric patients previously treated for malignancy. AJR Am J Roentgenol 2012; 199:186-91. [PMID: 22733911 DOI: 10.2214/ajr.11.7690] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the time course, cause, and imaging characteristics of all new liver lesions in pediatric patients with a previously treated malignancy. MATERIALS AND METHODS Our hospital cancer registry was used to identify patients between 1980 and 2005 who met the following criteria: solid tumor, survival > 2 years after diagnosis, no liver lesions at a posttreatment baseline, and cross-sectional imaging follow-up of > 2 years. Final dictated reports of all cross-sectional imaging examinations including the abdomen were reviewed for any mention of new liver lesions. Positive reports were followed by consensus review of the images and clinical data. Patients were divided into three groups: those with suspected or proven focal nodular hyperplasia (FNH), those with suspected or proven metastases, and those with other lesions. An exact Wilcoxon test was used to evaluate the differences between the groups. RESULTS Of 967 patients who met the initial inclusion criteria, 273 had adequate follow-up to be included in the study. Forty-six patients (16.8%) developed new liver lesions during the study period, and 14 of those 46 were classified into the FNH group (30.4%) and seven were classified into the metastasis group (15.2%). A significant difference was found in the median time to the development of FNH versus metastasis and other lesions (FNH, 92.9 months; metastasis, 43.2 months; other lesions, 18.5 months; p < 0.0001). A significant difference was also seen in the median length of follow-up between the groups (FNH, 115.6 months; metastasis, 57 months; other lesions, 50.8 months; p = 0.002). The imaging features of the groups also differed. CONCLUSION The most common liver lesion encountered in pediatric patients previously treated for malignancy was FNH, which occurred farther from the time of diagnosis and had different imaging characteristics from both metastases and other liver lesions.
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42
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Abstract
Liver tumors in children can be classified into benign or malignant; some of the benign lesions can have the potential of malignant transformation, and therefore the therapeutic approach may change. These neoplasms account for nearly 1-2% of all pediatric tumors and they have gained significant attention in the last decades due to data suggesting that the incidence may be increasing 5% annually. We know that with new and improved imaging modalities some of these lesions may be detected more often than before. Recent studies showed that liver cancer represented 2% of malignancies in infants by 1980s and this was doubled in incidence to 4% in the following 10 yr. In this review our aim is to discuss all primary liver tumors in children with attention to their clinicopathological and immunohistochemical features followed by the current standard of care.
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Affiliation(s)
- Sukru Emre
- Department of Surgery, Yale University School of Medicine, Yale, New Haven, CT, USA.
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43
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Thoolen B, ten Kate FJ, van Diest PJ, Malarkey DE, Elmore SA, Maronpot RR. Comparative histomorphological review of rat and human hepatocellular proliferative lesions. J Toxicol Pathol 2012; 25:189-99. [PMID: 22988337 PMCID: PMC3434334 DOI: 10.1293/tox.25.189] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/24/2012] [Indexed: 02/07/2023] Open
Abstract
In this comparative review, histomorphological features of common nonneoplastic and neoplastic hepatocyte lesions of rats and humans are examined using H&E-stained slides. The morphological similarities and differences of both neoplastic (hepatocellular carcinoma and hepatocellular adenoma) and presumptive preneoplastic lesions (large and small cell change in humans and foci of cellular alteration in rats) are presented and discussed. There are major similarities in the diagnostic features, growth patterns and behavior of both rat and human hepatocellular proliferative lesions and in the process of hepatocarcinogenesis. Further study of presumptive preneoplastic lesions in humans and rats should help to further define their role in progression to hepatocellular neoplasia in both species.
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Affiliation(s)
- Bob Thoolen
- Global Pathology Support, Benoordenhoutseweg 23, 2596 BA The
Hague, The Netherlands
- University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, The Netherlands
| | - Fiebo J.W. ten Kate
- University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, The Netherlands
| | - Paul J. van Diest
- University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, The Netherlands
| | - David E. Malarkey
- National Toxicology Program, National Institute of
Environmental Health Sciences, Cellular and Molecular Pathology Branch,111 T.W. Alexander
Drive, NC 27709, USA
| | - Susan A. Elmore
- National Toxicology Program, National Institute of
Environmental Health Sciences, Cellular and Molecular Pathology Branch,111 T.W. Alexander
Drive, NC 27709, USA
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44
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Hepatoblastoma imaging with gadoxetate disodium-enhanced MRI--typical, atypical, pre- and post-treatment evaluation. Pediatr Radiol 2012; 42:859-66. [PMID: 22419052 DOI: 10.1007/s00247-012-2366-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/11/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
Gadoxetate disodium (Gd-EOB-DTPA) is a hepatobiliary MRI contrast agent widely used in adults for characterization of liver tumors and increasingly used in children. Hepatoblastoma is the most common primary hepatic malignancy of childhood. In this review, we describe our experience with this agent both before and after initiating therapy in children with hepatoblastoma.
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45
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Hager T, Klein-Franke A, Jaschke W, Zelger B, Hager J. [Focal nodular hyperplasia in a 12-year-old boy: case report and considerations]. DER PATHOLOGE 2012; 33:254-61. [PMID: 22383052 DOI: 10.1007/s00292-012-1567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a benign hepatic tumor of unknown origin. It is only observed rarely in children (approximately 1-2% of all pediatric liver tumors). CASE REPORT A 12-year-old boy who suffered from infectious mononucleosis with liver involvement and hepatomegaly underwent a sonographic scan of the liver at an external hospital 3 months after the infection disappeared which revealed a tumor of the left hepatic lobule. Subsequent further examination (abdominal CT and MRT scans) confirmed the diagnosis of a highly vascularized mass about 10 cm in diameter, suspicious for FNH. Due to the high vascularization no biopsy was performed. A preoperative angiographic coiling and complete surgical resection was carried out because of the size and morphologic uncertainty. The diagnosis of FNH was confirmed by histological examination. The annual sonographic examination at follow-up has been uneventful for a 4-year period. CONCLUSIONS Due to the rarity the diagnosis of FNH in children can be difficult leading to differential diagnostic problems. Due to the risk of bleeding in larger size tumors a biopsy is a point of controversy. Complete resection and histopathological examination of FNHs in childhood is a mandatory therapeutic option, which may be indicated in large tumors or, as in the present case tumors of uncertain biological behaviour.
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Affiliation(s)
- T Hager
- Institut für Pathologie, Universitätsklinik/Medizinische Universität Innsbruck, Innsbruck, Österreich.
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46
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Characterization of pediatric liver lesions with gadoxetate disodium. Pediatr Radiol 2011; 41:1183-97. [PMID: 21701987 DOI: 10.1007/s00247-011-2148-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/11/2011] [Accepted: 04/15/2011] [Indexed: 12/17/2022]
Abstract
Gadoxetate disodium (Gd-EOB-DTPA) is a relatively new hepatobiliary MRI contrast agent. It is increasingly used in adults to characterize hepatic masses, but there is little published describing its use in children. The purpose of this paper is to describe our pediatric MRI protocol as well as the imaging appearance of pediatric liver lesions using gadoxetate disodium. As a hepatocyte-specific MRI contrast agent, Gd-EOB-DTPA has the potential to improve characterization and provide a more specific diagnosis of pediatric liver masses.
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