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MRI features of hepatocellular adenomas in children: clinical and radiological review
Musab Almushayqih1,2, Rose Chami3,4, Caroline Rutten1,5
1Diagnostic and Interventional Radiology Department, Hospital for Sick Children, 555 University Ave, Toronto M5G 1X8, Toronto, Canada.
Insights
Hepatocellular adenomas (HCAs) in children are rare benign liver tumors. MRI findings like T2 hyperintensity, arterial enhancement, and intralesional fat are common, though not specific for diagnosis.
Area of Science:
- Pediatric Radiology
- Hepatobiliary Imaging
- Oncology
Background:
- Hepatocellular adenomas (HCAs) are uncommon benign liver tumors in pediatric patients.
- Limited imaging data exists for pediatric HCAs, complicating diagnosis.
- Accurate imaging characterization is crucial for appropriate management.
Purpose of the Study:
- To detail the magnetic resonance imaging (MRI) characteristics of pediatric hepatocellular adenomas.
- To correlate imaging findings with clinical presentation and pathology.
- To enhance diagnostic accuracy for HCAs in children.
Main Methods:
- Retrospective review of 13 pathologically confirmed HCAs in 11 children (2004-2024).
- Analysis of pre-intervention MRI scans by two independent readers.
- Descriptive statistics and inter-reader agreement (Cohen's kappa) were used.
Main Results:
- HCAs presented as well-defined lesions (median diameter 3.6 cm).
- Common MRI features included T1 isointensity, mild T2 hyperintensity, and arterial phase hyperenhancement (90%).
- Intralesional fat was frequent (69.2%), while hepatobiliary contrast uptake was variable (30% retention).
Conclusions:
- Pediatric HCA MRI features are not entirely specific.
- Homogenous slight T2 hyperintensity, arterial phase hyperenhancement, and intralesional fat are key indicators.
- Variable hepatobiliary contrast uptake necessitates careful interpretation.
Background:
Hepatocellular adenomas (HCAs) are rare, benign hepatic tumors in children, with limited imaging data available for pediatric cases.
Objective:
To describe the magnetic resonance imaging (MRI) and clinical features of histologically proven HCAs in children.
Materials And Methods:
Single-center retrospective review of pathology-proven HCA from January 2004 to February 2024. Patients with available pre-intervention imaging in our PACS were included. Two independent readers reviewed the imaging studies. The features were summarized using descriptive statistics and inter-reader agreement was assessed using Cohen's kappa.
Results:
This study included 11 children (6 boys and 5 girls; median age 15 years) with 13 pathologically proven HCAs. Three patients had type 1a glycogen storage disease. Five patients had a single lesion, while six had multiple lesions. The lesions were well-defined with a median average diameter of 3.6 cm. Most were homogenously T1 iso-intense (61.5%) and mildly hyperintense (76.9%) on T2-w fat saturated images. The atoll sign was present in two lesions. Intralesional fat was observed in 69.2% of cases: microscopic in eight lesions and macroscopic in one. Hemorrhage occurred in three (23.07%) lesions and necrosis in one (7.7%). Nine out of 10 (90%) lesions showed arterial phase hyperenhancement, and only 3/10 (30%) lesions retained contrast on hepatobiliary phase. In total, 6/13 (46.1%) lesions showed washout, and all received hepatobiliary agent. One lesion ruptured with the hemoperitoneum. Of the 11, 63.6% of patients underwent percutaneous biopsy and 36.4% underwent surgical resection.
Conclusion:
MR imaging features are nonspecific, but homogenous slight T2 hyperintensity, arterial phase hyperenhancement, and intralesional fat content are common features. Hepatobiliary contrast uptake is variable.
