Related Experiment Video
Updated: Aug 23, 2025
Troubleshooting FoCUS Image Acquisition: Patient Positioning, Transducer Manipulation, and Image Optimization
Published on: March 3, 2023
Optimizing Imaging of Pediatric Liver Lesions: Guidelines from the Pediatric LI-RADS Working Group
Govind B Chavhan1, Gary R Schooler1, Elizabeth R Tang1
1From the Department of Diagnostic Imaging, The Hospital for Sick Children, and Medical Imaging Department, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8 (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Seattle Children's Hospital, Seattle, Wash (E.R.T.); Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Singleton Department of Radiology, Texas Children's Hospital, Houston, Tex (H.T.N.N.); Departments of Radiology (C.E.M., A.J.T.) and Pediatrics (A.J.T.), Cincinnati Children's Hospital, Cincinnati, Ohio; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (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 (G.K., A.L.A.); and Department of Radiology, Nemours Children's Hospital Florida, Orlando, Fla (J.C.I.).
Insights
This study provides guidelines for imaging pediatric liver lesions, emphasizing age- and indication-based approaches. Tailored imaging techniques ensure optimal diagnosis while minimizing invasiveness for children.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Hepatology
Background:
- Pediatric liver lesions require tailored imaging due to variations in children's size and cooperation.
- Sedation or anesthesia can often be avoided with specific imaging techniques.
Purpose of the Study:
- To provide guidelines for the imaging workup of pediatric focal liver lesions.
- To offer an indication- and age-based approach for selecting imaging techniques and modalities.
Main Methods:
- Review of existing literature and collective experience from the Liver Imaging and Reporting Data System Pediatric Working Group.
- Discussion of various imaging techniques including ultrasound (US), MRI, and CT, with a focus on contrast-enhanced modalities.
- Emphasis on tailoring protocols for different age groups and clinical presentations.
Main Results:
- Ultrasound (US) is typically the initial imaging modality for suspected abdominal masses.
- Multiphasic contrast-enhanced MRI is recommended for characterizing most hepatic lesions.
- Contrast-enhanced CT serves as an alternative for patients with MRI contraindications, and contrast-enhanced US shows promise for specific lesions.
Conclusions:
- An age- and indication-based approach is crucial for effective imaging of pediatric liver lesions.
- Selecting appropriate imaging techniques and protocols optimizes diagnostic accuracy and patient care.
- Advanced imaging modalities like MRI and CT, alongside US, play vital roles in diagnosis and management.
Abstract:
A differential diagnosis based on a patient's age, clinical presentation, and serum α-fetoprotein level will help guide the initial imaging workup in children with a liver lesion. Children vary significantly in size, the ability to stay still, and the ability to breath hold for imaging examinations. Choosing and tailoring imaging techniques and protocols for each indication and age group is important for optimal care with minimal invasiveness. The need for sedation or anesthesia can be obviated by using techniques like feed and bundle, distraction, contrast-enhanced US, and motion-insensitive sequences for MRI. US is often the first imaging modality used in children with a suspected abdominal mass. Once a hepatic lesion is confirmed, multiphasic contrast-enhanced MRI is recommended for most lesions as the next imaging modality allowing full characterization of the lesion and assessment of the liver parenchyma. Contrast-enhanced CT can also be performed for assessment of pediatric focal liver lesions, especially in patients who have a contraindication to MRI. Contrast-enhanced US has shown promise to decrease the need for MRI or CT in some lesions such as hemangioma and focal nodular hyperplasia. Children with a history of malignancy can develop multiple types of hepatic lesions at various stages, including infections during an immunocompromised state, manifesting as focal liver lesions. Based on available limited data in the literature and the collective experiences of the Liver Imaging and Reporting Data System Pediatric Working Group, the authors provide guidelines for the imaging workup of pediatric focal liver lesions with an indication- and age-based approach and discuss the selection and performance of various imaging techniques and modalities. ©RSNA, 2022 See the invited commentary by Chojniak and Boaventura in this issue.
