Differentiating focal nodular hyperplasia from hepatic adenoma using a multimodality approach in children

Radiological characterisation of liver tumours in children aims to differentiate benign from malignant or potentially malignant lesions, and where possible, obviate the need for biopsy. This approach aims to reduce unnecessary morbidity and parental/patient anxiety and promotes judicious use of radiological and surgical resources. Focal nodular hyperplasia (FNH) and hepatic adenoma usually have a benign course but require tailored imaging follow-up and management due to their propensity to enlarge and/or mimic malignancy. In the case of hepatic adenoma, malignant transformation and tumour haemorrhage/rupture are the key concerns. This paper will discuss the clinical course of these two entities, their typical imaging findings on a range of modalities and how this impacts decision-making at the clinical level. The utility of hepatobiliary-specific MRI contrast agents will be discussed with reference to their key role in differentiating FNH from hepatic adenoma, whilst highlighting limitations and potential interpretation pitfalls.