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Updated: Nov 11, 2025
Non-Invasive PET/MR Imaging in an Orthotopic Mouse Model of Hepatocellular Carcinoma
Published on: August 31, 2022
Imaging and clinical features of pediatric hepatocellular carcinoma
Guillermo A Arias1,2, Iram Siddiqui3, Oscar M Navarro1,2
1Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
Insights
Pediatric hepatocellular carcinoma (HCC) presents as large, heterogeneous tumors, often involving the portal vein and caudate lobe, impacting resectability. Fibrolamellar HCC may be distinguished by a central scar and normal alpha-fetoprotein levels.
Area of Science:
- Radiology
- Pediatric Oncology
- Hepatobiliary Imaging
Background:
- Hepatocellular carcinoma (HCC) is a rare malignancy in pediatric populations.
- Limited data exists regarding the specific imaging characteristics of pediatric HCC.
Purpose of the Study:
- To delineate the imaging features of pediatric HCC.
- To correlate these imaging findings with clinical, laboratory, and pathological data.
Main Methods:
- Retrospective review of imaging (CT, MRI, ultrasound) for pediatric HCC cases from 2000-2019.
- Application of LI-RADS and PRETEXT criteria for tumor characterization and staging.
- Correlation with clinical, alpha-fetoprotein (AFP), and pathology data.
Main Results:
- Fifteen pediatric HCC cases were analyzed, with varied pathological subtypes including classic, fibrolamellar, and mixed cholangiocarcinoma-HCC.
- Imaging revealed common features such as arterial phase hyperenhancement (83%), washout (86%), and multifocality (40%).
- High PRETEXT staging (II-IV) was noted, with frequent portal vein (71%) and caudate lobe (43%) involvement. Fibrolamellar HCC showed distinct features like central scar and normal AFP.
Conclusions:
- Pediatric HCCs are typically large, heterogeneous tumors with advanced staging at presentation, often involving critical liver structures.
- These findings influence surgical resectability.
- Specific imaging findings like central scars can aid in differentiating fibrolamellar HCC from other HCC subtypes.
Background:
Hepatocellular carcinoma (HCC) is rare in children and there is limited data on its imaging features.
Objective:
To describe imaging features of pediatric HCC and correlate them with clinical and laboratory findings.
Materials And Methods:
We retrospectively reviewed imaging in all pediatric HCC cases seen between January 2000 and January 2019. Imaging features defined in LI-RADS (Liver Imaging Reporting and Data System) and tumor extent by PRETEXT (pretreatment extent of disease) criteria were noted by two radiologists. Patient charts were reviewed to collect clinical features, alpha-fetoprotein (AFP) level and pathology findings.
Results:
Of the 15 children (7 boys, 8 girls; mean age: 11.8 years, age range: 6-17 years) included in the study, 12/15 had computed tomography, 9/15 had magnetic resonance imaging and 9/15 had ultrasound exams available for review. Pathological types of HCC included classic (11/15, 73%), fibrolamellar (3/15, 20%) and mixed cholangiocarcinoma-HCC (1/15, 7%). Eighty percent occurred de novo in normal liver and 67% showed elevated AFP levels. Arterial phase hyperenhancement was seen in 83% of cases, washout in 86%, capsule in 50% and tumor-in-vein in 33%. The mean tumor size was 9.8 cm and 40% were multifocal on imaging. Staging revealed PRETEXT II tumors in 47%, III in 20% and IV in 33%. There were no PRETEXT I tumors. The two most common PRETEXT annotation factors were portal vein and caudate lobe involvement in 71% and 43% of cases, respectively. Fibrolamellar HCC demonstrated central scar, normal AFP levels and normal background liver.
Conclusion:
Pediatric HCC are large heterogeneous tumors, as reflected by high PRETEXT staging, and commonly include portal vein and caudate involvement. This affects resectability of these tumors at presentation. Central scar, normal AFP level and normal liver background may help differentiate fibrolamellar HCC from other types of HCC.
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