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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0044-1785208
Original Article

Can Dynamic Contrast-Enhanced MRI be Used to Differentiate Hepatic Hemangioma from Other Lesions in Early Infancy?

Dan Halevy
1   Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
,
Blayne A. Sayed
3   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
4   Department of Surgery, University of Toronto, Toronto, Ontario, Canada
,
Furqan Shaikh
5   Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
6   Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
,
Iram Siddiqui
6   Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
7   Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Govind B. Chavhan
1   Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations Funding None.
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Abstract

Background Confident diagnosis of hepatic hemangioma on imaging can avoid biopsy in early infancy and helps guide conservative management.

Purpose This article aims to determine if dynamic contrast-enhanced magnetic resonance imaging (MRI) can be used to differentiate liver hemangioma from other lesions in infants ≤ 100 days and to determine association of MRI features with hepatic lesions.

Methods MRI performed for liver lesions were retrospectively reviewed to note imaging characteristics and the MRI diagnosis. Final diagnosis was assigned based on pathology in available cases and by corroborative standard of reference including overall clinical features, lab findings, and follow-up.

Results Of 30 infants (18 boys, 12 girls; average age 42.2 days) included, 18 had solitary and 12 had multifocal lesions. Diagnoses in total 33 lesions included hemangiomas (23), hepatoblastoma (6), arteriovenous malformation (2), neuroblastoma metastases (1), and infarction (1). MRI and final diagnosis matched in 94% lesions with almost perfect agreement (kappa 0.86) for reader 1, and matched in 88% lesions with substantial agreement (kappa 0.71) for reader 2. Interobserver agreement for MRI diagnosis was substantial (kappa 0.62). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI in differentiating hemangioma from other lesions were 100, 90, 96, 100, and 97%, respectively. Centripetal (16/23) or flash (5/23) filling were only seen with hemangioma. There was no significant difference in alpha-fetoprotein elevation (p 0.08), average size (p 0.35), multifocality (p 0.38), and intralesional hemorrhage (p 1) between hemangioma and hepatoblastoma.

Conclusion Centripetal filling on dynamic imaging and absence of washout are characteristic MRI features of hepatic hemangioma that can help to differentiate it from other lesions in early infancy.

Keywords

liver - neonate - infants - hemangioma - hepatoblastoma - imaging

Note

This study was presented as an abstract during International Pediatric Radiology Meeting 2021, Rome, Italy.




Publication History

Article published online:
21 April 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Lakhoo K, Sowerbutts H. Neonatal tumours. Pediatr Surg Int 2010; 26 (12) 1159-1168
    CrossrefPubMedGoogle Scholar
  • 2 Isaacs Jr H. Fetal and neonatal hepatic tumors. J Pediatr Surg 2007; 42 (11) 1797-1803
    CrossrefPubMedGoogle Scholar
  • 3 Kassarjian A, Zurakowski D, Dubois J, Paltiel HJ, Fishman SJ, Burrows PE. Infantile hepatic hemangiomas: clinical and imaging findings and their correlation with therapy. Am J Roentgenol 2004; 182 (03) 785-795
    CrossrefPubMedGoogle Scholar
  • 4 Iacobas I, Phung TL, Adams DM. et al. Guidance document for hepatic hemangioma (infantile and congenital) evaluation and monitoring. J Pediatr 2018; 203: 294-300.e2
    CrossrefPubMedGoogle Scholar
  • 5 Kulungowski AM, Alomari AI, Chawla A, Christison-Lagay ER, Fishman SJ. Lessons from a liver hemangioma registry: subtype classification. J Pediatr Surg 2012; 47 (01) 165-170
    CrossrefPubMedGoogle Scholar
  • 6 Rutten C, Ladarre D, Ackermann O, Gonzales E, Guettier C, Franchi-Abella S. Spontaneous evolution patterns of focal congenital hepatic hemangiomas: a case series of 25 patients. Pediatr Radiol 2022; 52 (06) 1048-1060
    CrossrefPubMedGoogle Scholar
  • 7 Darbari A, Sabin KM, Shapiro CN, Schwarz KB. Epidemiology of primary hepatic malignancies in U.S. children. Hepatology 2003; 38 (03) 560-566
    CrossrefPubMedGoogle Scholar
  • 8 Chavhan GB, Shelmerdine S, Jhaveri K, Babyn PS, Liver MR. Liver MR imaging in children: current concepts and technique. Radiographics 2016; 36 (05) 1517-1532
    CrossrefPubMedGoogle Scholar
  • 9 Khanna G, Chavhan GB, Schooler GR. et al. Diagnostic performance of LI-RADS version 2018 for evaluation of pediatric hepatocellular carcinoma. Radiology 2021; 299 (01) 190-199
    CrossrefPubMedGoogle Scholar
  • 10 Arias GA, Siddiqui I, Navarro OM, Shaikh F, Sayed BA, Chavhan GB. Imaging and clinical features of pediatric hepatocellular carcinoma. Pediatr Radiol 2021; 51 (08) 1339-1347
    CrossrefPubMedGoogle Scholar
  • 11 Singal AG, Llovet JM, Yarchoan M. et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 2023; 78 (06) 1922-1965
    CrossrefPubMedGoogle Scholar
  • 12 Chavhan GB, Farras Roca L, Coblentz AC. Liver magnetic resonance imaging: how we do it. Pediatr Radiol 2022; 52 (02) 167-176
    CrossrefPubMedGoogle Scholar
  • 13 Schooler GR, Squires JH, Alazraki A. et al. Pediatric hepatoblastoma, hepatocellular carcinoma, and other hepatic neoplasms: consensus imaging recommendations from American College of Radiology Pediatric Liver Reporting and Data System (LI-RADS) Working Group. Radiology 2020; 296 (03) 493-497
    CrossrefPubMedGoogle Scholar
  • 14 Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37 (05) 360-363
    PubMedGoogle Scholar
  • 15 Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000; 20 (02) 379-397
    CrossrefPubMedGoogle Scholar
  • 16 Schooler GR, Hull NC, Lee EY. Hepatobiliary MRI contrast agents: pattern recognition approach to pediatric focal hepatic lesions. AJR Am J Roentgenol 2020; 214 (05) 976-986
    CrossrefPubMedGoogle Scholar
  • 17 Ferraro S, Panzeri A, Braga F, Panteghini M. Serum α-fetoprotein in pediatric oncology: not a children's tale. Clin Chem Lab Med 2019; 57 (06) 783-797
    CrossrefPubMedGoogle Scholar
  • 18 Fernandez-Pineda I, Cabello-Laureano R. Differential diagnosis and management of liver tumors in infants. World J Hepatol 2014; 6 (07) 486-495
    CrossrefPubMedGoogle Scholar