Learning objectives
The aim of this review is to present the wide spectrum of common and uncommon focal liver diseases affecting neonatal and pediatric liver transplant candidates,
analyzed using ultrasonography (US),
16 or 64 multi-detector row helical CT (MDCT) and 1.5 T MRI fast imaging.
Correlation of imaging findings and explanted liver or histology is illustrated in representative cases.
Associated uncommon congenital anomalies are shown.
Background
Ultrasonography: According to the size of the patient,
studies may be performed using a microconvex,
convex or linear transducer,
with anterior and lateral approach,
without sedation.
This permits detection of morphologic changes in the liver,
hepatic focal lesions (cystic or solid) or abdominal masses,
and signs of portal hypertension,
such as hypersplenism,
perihepatic or perisplenic varices,
and ascites.
MDCT: Studies are usually performed with and without isosmolar or lower osmolar (Iodixanol 320 mgI/ml,
Optiray 320,
respectively) intravenous contrast material (IVCM),
with a dose of 1.5...
Imaging findings OR Procedure details
Hepatoblastoma
Hepatoblastoma (HB),
the most common pediatric hepatic malignancy,
accounts for 1% of all pediatric malignancies and for 79% of all liver cancers in children under the age of 15,
and is more common in boys (M:F ratio of 3.6:1) (1-3).
HBs are classified as either epithelial (56%) or mixed epithelial/mesenchymal (44%).
The epithelial group is further subdivided into fetal (31%),
embryonal (19%),
macrotrabecular (3%) and small-cell undifferentiated subtypes (3%).
Pure fetal histology is associated with a better prognosis,
while undifferentiated histology is associated with...
Conclusion
Pediatric liver transplantation is the standard of care for patients with end-stage liver diseases.
US is usually the first imaging modality utilized for evaluating a patient because it is easy to perform,
widely available,
and relatively inexpensive.
MDCT and fast MRI imaging play a key role in pre-transplantation workup,
allowing for the staging of liver disease and the evaluation of associated congenital anomalies.
Personal Information
Settimo Caruso,
Radiologist
Department of Diagnostic and Interventional Radiology
Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT),
University of Pittsburgh Medical Center Italy,
Via Tricomi 1,
Palermo 90127,
Italy
e/mail:
[email protected]
References
Avila LF,Luis AL,Hernandez F,Garcia Miguel P,Jara P,Andres AM,Lopez Santamaría M,Tovar JA.
Liver transplantation for malignant tumours in children.Eur J Pediatr Surg.2006 Dec;16(6):411-4.
Meyers RL.
Tumors of the liver in children.Surg Oncol.2007 Nov;16(3):195-203.
Emre S,McKenna GJ.
Liver tumors in children.Pediatr Transplant.2004 Dec;8(6):632-8.
Comert S,Vitrinel A,Akin Y,Mutlu GY,Tokuc G,Bakir B.
Abdominal mass in a neonate: hepatoblastoma.Indian J Pediatr.2007 Oct;74(10):956-8.
Van Tornout JM,Buckley JD,Quinn JJ,Feusner JH,Krailo MD,King DR,Hammond GD,Ortega JA.
Timing and magnitude of decline in alpha-fetoprotein levels in treated children with unresectable or metastatic hepatoblastoma are predictors...
