Semin Liver Dis 2001; 21(2): 251-270
DOI: 10.1055/s-2001-15339
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Pediatric Liver Imaging

Marilyn J. Siegel
  • Malllinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
Further Information

Publication History

Publication Date:
31 December 2001 (online)

ABSTRACT

The evaluation of hepatic diseases in children is often a multimodality process, requiring multiple imaging tests to determine the cause and extent of an abnormality. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) have distinct roles to play in the evaluation of hepatic disease in children. This article addresses the hepatic and biliary lesions that are unique or more common in children and describes their cross-sectional imaging characteristics. In addition, the techniques and protocols for US, CT, and MRI are reviewed.

REFERENCES

  • 1 Greenberg M, Filler R M. Hepatic tumors.  In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology  Philadelphia: Lippincott-Raven. 1997;  717-732
  • 2 Donnelly L F, Bisset III S G. Pediatric hepatic imaging.  Radiol Clin North Am . 1998;  36 413-427
  • 3 Siegel M J. Liver.  In: Siegel MJ, ed. Pediatric Body Sonography, 3rd ed  Philadelphia: Lippincott Williams & Wilkins (in press)  
  • 4 Siegel M J. Liver and biliary tract.  In: Siegel MJ, ed. Pediatric Body CT  Philadelphia: Lippincott Williams & Wilkins. 1999;  141-174
  • 5 Taylor G A. Acute hepatic disease.  Radiol Clin North Am . 1997;  35 799-813
  • 6 Boechat M I, Kangarloo H, Gilsanz V. Hepatic masses in children.  Semin Roentgenol . 1988;  3 185-193
  • 7 Boechat M I, Kangarloo H, Ortega J. Primary liver tumors in children: comparison of CT and MR imaging.  Radiology . 1988;  169 727-732
  • 8 Davey M S, Cohen M D. Imaging of gastrointestinal malignancy in childhood.  Radiol Clin North Am . 1996;  34 717-742
  • 9 Finn J P, Hall-Craggs M A, Dicks-Mireaux C. Primary malignant liver tumours in childhood: assessment of resectability with high-field MR and comparison with CT.  Pediatr Radiol . 1990;  21 34-38
  • 10 Pobeil R S, Bisset G S. Pictorial essay: imaging of liver tumors in the infant and child.  Pediatr Radiol . 1995;  25 495-506
  • 11 Weinreb J C, Cohen J M, Armstrong E. Imaging the pediatric liver: MRI and CT.  AJR . 1986;  147 785-790
  • 12 Siegel M J, Luker G D. MR imaging of the liver in children.  MRI Clin North Am . 1996;  637-656
  • 13 Siegel M J. Practical CT techniques In: Siegel MJ, ed. Pediatric Body CT.  Philadelphia: Lippincott Williams & Wilkins 1999: 1-41
  • 14 Kaste S C, Young C W. Safe use of power injectors with central and peripheral venous access devices for pediatric CT.  Pediatr Radiol . 1995;  26 499-501
  • 15 Luker G D, Siegel M J, Bradley D A, Baty J D. Hepatic spiral CT in children: scan delay time-enhancement analysis.  Pediatr Radiol . 1996;  26 337-340
  • 16 Roche K J, Genieser N B, Ambrosino M M. Pediatric hepatic CT: an injection rate.  Radiology . 1996;  26 502-507
  • 17 Siegel M J. Protocols for helical CT in pediatrics. In: Silverman PM, ed. Helical (Spiral) Computed Tomography Philadelphia: Lippincott-Raven 1998: 179-224
  • 18 American Society of Anesthesiologists Task Force. Practice guidelines for sedation and analgesia by non-anesthesiologist: a report by the American Society of Anesthesiologists Task Force on sedation and analgesia by non-anesthesiologists.  Anesthesiology . 1996;  84 459-471
  • 19 Bisset III S G, Ball W S. Preparation, sedation and monitoring of the pediatric patient in the magnetic resonance suite.  Semin Ultrasound CT MR . 1991;  2 376-378
  • 20 Committee on Drugs, American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.  Pediatrics . 1992;  89 1110-1115
  • 21 Cote C J. Sedation for pediatric patient: a review.  Pediatr Clin North Am . 1994;  41 31-56
  • 22 Frush D P, Bisset III S G, Hall S C. Pediatric sedation in radiology: the practice of safe sleep.  AJR . 1996;  167 1381-1387
  • 23 Pereira J K, Burrows P E, Richards H M, Chuang S H, Babyn P S. Comparison of sedation regimens for pediatric outpatient CT.  Pediatr Radiol . 1993;  23 341-344
  • 24 Strain J D, Campbell J B, Harvey L A, Foley, L C. IV Nembutal: safe sedation for children undergoing CT.  AJR . 1988;  151 955-959
  • 25 Scuza R A, Narla L D. Primary endodermal sinus tumor of the liver detected by CT.  Pediatr Radiol . 1992;  22 449-450
  • 26 Mukai J K, Stack C M, Turner D A. Imaging of surgically relevant hepatic vascular and segmental anatomy. Part 2. Extent and resectability of hepatic neoplasm.  AJR . 1987;  149 293-297
  • 27 Ni Y-H, Chang M-H, Hsu H-Y. Hepatocellular carcinoma in childhood: clinical manifestations and prognosis.  Cancer . 1991;  68 1737-1741
  • 28 Breuer C K, Vacanti J P. Surgical liver disease. In: Oldham KT, Colombani PM, Foglia RP, eds. Surgery of Infants and Children: Scientific Principles and Practice Philadelphia: Lippincott-Raven 1997: 1385-1394
  • 29 Koneru B, Flye M W, Busuttil R W. Liver transplantation for hepatoblastoma: the American experience.  Ann Surg . 1991;  213 118-121
  • 30 Jabra A A, Fishman E K, Taylor G A. Hepatic masses in infants and children: CT evaluation.  AJR . 1992;  158 143-149
  • 31 Van Campenhout I, Patriquin H. Malignant microvasculature in abdominal tumors in cildren: detection with Doppler US.  Radiology . 1992;  183 445-448
  • 32 Horton K M, Bluemke D A, Hruban R H, Soyer P, Fishman E K. CT and MR imaging of benign hepatic and biliary tumors.  RadioGraphics . 1999;  19 431-451
  • 33 Men S, Hekimogluw B, Tuzun M, Arda I S, Pinar A. Unusual US and CT findings in hepatoblastoma: a case report.  Pediatr Radiol . 1995;  25 507-508
  • 34 Powers C, Ros P R, Stoupis C, Johnson W K, Segel K H. Primary liver neoplasms: MR imaging with pathologic correlation.  RadioGraphics . 1994;  459-482
  • 35 Finegold M J. Tumors of the liver.  Semin Liver Dis . 1994;  14 270-281
  • 36 Taylor K JW, Ramos I, Morse S S, Fortune K L, Hammers L, Taylor C R. Focal liver masses: differential diagnosis with pulsed Doppler US.  Radiology . 1987;  64 643-647
  • 37 Itoh K, Nishimura K, Togashi K. Hepatocellular carcinoma: MR imaging.  Radiology . 1987;  164 21-25
  • 38 Brandt D J, Johnson C D, Stephens D H, Weiland L H. Imaging of fibrolamellar hepatocellular carcinoma.  AJR . 1988;  151 295-299
  • 39 McLarney J K, Rucker P T, Bender G N. Fibrolamellar carcinoma of the liver: radiologic-pathologic correlation.  RadioGraphics . 1999;  19 453-471
  • 40 Soyer P, Roche A, Levesque M, Legmann P. CT of fibrolamellar hepatocellular carcinoma.  J Comput Assist Tomogr . 1991;  15 533-538
  • 41 Stevens W R, Johnson C D, Stephens D H, Nogorney D M. Fibrolamellar hepatocellular carcinomas: stage at presentation and results of aggressive surgical management.  AJR . 1995;  164 1153-1158
  • 42 Ichikawa T, Federle M P, Grazioli L, Madariaga J, Nalesnik M, Marsh W. Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases.  Radiology . 1999;  213 352-361
  • 43 Ros P R, Olmsted W W, Dachman A H. Undifferentiated (embryonal) sarcoma of the liver: radiologic-pathologic correlation.  Radiology . 1986;  160 141-145
  • 44 Buetow P C, Buck J L, Pantongrag-Brown L. Undifferentiated (embryonal) sarcoma of the liver: pathologic basis of imaging findings in 28 cases.  Radiology . 1997;  203 779-783
  • 45 Moon W K, Kim W S, Kim I O. Undifferentiated embryonal sarcoma of the liver: US and CT findings.  Pediatr Radiol . 1994;  24 500-503
  • 46 Pickhardt P J, Siegel M J. Abdominal manifestations of postransplantation lymphoproliferative disorder.  AJR . 1998;  171 1007-1013
  • 47 Pickhardt P J, Siegel M J. Postransplantation lymphoproliferative disorder of the abdomen: CT evaluation in 51 patients.  Radiology . 1999;  213 73-78
  • 48 Pickhardt P J, Siegel M J, Hayashi R J, Kelly M. State of the art.  postransplantation lymphoproliferative disorder in children: clinical, histopathologic and imaging features. Radiology . 2000;  16-25
  • 49 Keslar P J, Buck J L, Selby D M. Infantile hemangioendothelioma of the liver revisited.  RadioGraphics . 1993;  13 657-670
  • 50 Awan S, Davenport M, Portmann B, Howard E R. Angiosarcoma of the liver in children.  J Pediatr Surg . 1996;  31 1729-1732
  • 51 Chandra R S, Stocker J T. The liver, gallbladder and biliary tract. In: Stocker JT, Dehner LP, eds. Pediatric Pathology Philadelphia: Lippincott 1993: 703-789
  • 52 Kirchner S G, Heller R M, Kasselberg A G. Infantile hepatic hemangioendothelioma with subsequent malignant degeneration.  Pediatr Radiol . 1981;  11 42-45
  • 53 Klein M A, Slovis T L, Chang C H, Jacobs I G. Sonographic and Doppler features of infantile hepatic hemangiomas with pathologic correlation.  J Ultrasound Med . 1990;  9 619-624
  • 54 Paltiel H J, Patriquin H B, Keller M S, Babcock D S, Leithiser Jr E R. Infantile hepatic hemangioma: Doppler US.  Radiology . 1992;  182 735-742
  • 55 Lucaya J, Enriquez G, Amat L, Gonzalez-Rivero M A. Computed tomography of infantile hepatic hemangioendothelioma.  AJR . 1985;  144 821-826
  • 56 Mahboubi S, Sunaryo F P, Glassman M S, Patel K. Computed tomography, management, and follow-up in infantile hemangioendothelioma of the liver in infants and children.  J Comput Assist Tomogr . 1987;  11 370-375
  • 57 Stanley P, Geer G D, Miller J H, Gilsanz V, Landing B H, Boechat I M. Infantile hepatic hemangiomas: clinical features, radiologic investigations, and treatment of 20 patients.  Cancer . 1989;  64 936-949
  • 58 Mortele K, Mergo P J, Urrutia M, Ros P R. Dynamic gadolinium-enhanced MR findings in infantile hepatic hemangioendothelioma.  JCAT . 1998;  22 714-717
  • 59 Leary D L, Weiskittel D A, Blane C E, Coran A G. Follow-up imaging of benign pediatric liver tumors.  Pediatr Radiol . 1989;  19 234-236
  • 60 Fellows K E, Hoffer F A, Markowitz R I, O'Neill J A. Multiple collaterals to hepatic infantile hemangioendotheliomas and arteriovenous malformations: effect on embolization.  Radiology . 1991;  181 813-818
  • 61 Tarazov P G, Polysalov V N, Ryshkov V K. Hemangiomatosis of the liver and spleen: successful treatment with embolization and splenectomy.  AJR . 1990;  155 1235-1236
  • 62 Ros P R, Goodman Z D, Ishak K G. Mesenchymal hamartoma of the liver: radiologic-pathologic correlation.  Radiology . 1986;  158 619-624
  • 63 George J C, Cohen M D, Tarver R D, Rosales R N. Ruptured cystic mesenchymal hamartoma: an unusual cause of neonatal ascites.  Pediatr Radiol . 1994;  24 304-305
  • 64 Ramanujam T M, Goh D W, Wong K T. Malignant transformation of mesenchymal hamartoma of the liver: case report and review of the literature.  J Pediatr Surg . 1999;  334 1684-1686
  • 65 Stanley P, Hall T R, Woolley M M. Mesenchymal hamartomas of the liver in childhood: sonographic and CT findings.  AJR . 1986;  147 1035-1039
  • 66 Buetow P C, Pantongrag-Brown L, Buck J L, Ros P R, Goodman Z D. Focal nodular hyperplasia of the liver: radiologic-pathologic correlation.  RadioGraphics . 1996;  16 369-388
  • 67 Carlson S K, Johnson C D, Bender C E, Welch T J. CT of focal nodular hyperplasia of the liver.  AJR . 2000;  174 705-712
  • 68 Mathieu D, Bruneton J N, Drouillard J, Pointreau C C, Vasile N. Hepatic adenomas and focal nodular hyperplasia: dynamic CT study.  Radiology . 1986;  160 53-58
  • 69 Toma P, Taccone A, Martinoli C. MRI of hepatic focal nodular hyperplasia: a report of two new cases in the pediatric age group.  Pediatr Radiol . 1990;  20 267-269
  • 70 Caseiro-Alves F, Zins Marc, Mahfouz A-E. Calcification in focal nodular hyperplasia: a new problem for differentiation from fibrolamellar hepatocellular carcinoma.  Radiology . 1996;  198 889-892
  • 71 Paulson E K, McClellan J S, Washington K. Hepatic adenoma: MR characteristics and correlation with pathologic findings.  AJR. 1994;  163 113-116
  • 72 Pastakia B, Shawker T H, Thaler M, O Leary T, Pizzo P A. Hepatosplenic candidiasis: wheels within wheels.  Radiology . 1988;  166 417-421
  • 73 Shirkhoda A. CT findings in hepatosplenic and renal candidiasis.  J Comput Assist Tomogr . 1987;  11 795-798
  • 74 Hopkins K L, Simoneaus S F, Patrick L E, Wyly J B, Dalton M J, Snitzer J A. Imaging manifestations of cat-scratch disease.  AJR . 1996;  166 435-438
  • 75 Gubernick J A, Rosenberg H K, Ilaslan H, Kessler A. US approach to jaundice in infants and children.  RadioGraphics . 2000;  20 173-195
  • 76 Miyazaki T, Yamashita Y, Tang Y. Single-shot MR cholangiopancreatography of neonates, infants, and young children.  AJR . 1998;  170 33-37
  • 77 Roberts E A. The jaundiced baby. In: Kelly DA, ed. Diseases of the Liver and Biliary System in Children Oxford, UK: Blackwell Science 1999: 11-45
  • 78 Kasai M. Treatment of biliary atresia with special reference to hepatic portoenterostomy and its modifications.  Progr Ped Surg . 1987;  6 5-52
  • 79 Choi S-O, Park W-H, Lee H-J, Woo S-K. ``Triangular cord'': a sonographic finding applicable in the diagnosis of biliary atresia.  J Pediatr Surg . 1996;  31 363-366
  • 80 Park W-H, Choi S-O, Lee H-J. The ultrasonographic ``triangular cord'' coupled with gallbladder images in the diagnostic prediction of biliary atresia from infantile intrahepatic cholestasis.  J Pedatr Surg . 1999;  34 1706-1710
  • 81 Kendrick A PT, Phua K B, Subramaniam R, Goh A SW, Ooi B C, Tan C E. Making the diagnosis of biliary atresia using the triangular cord sign and gallbladder length.  Pediatr Radiol . 2000;  30 69-7383
  • 82 Kim M-J, Park Y N, Han S J. Biliary atresia in neonates and infants: triangular area of high signal intensity in the porta hepatis at T2-weighed MR cholangiography with US and histopathologic correlation.  Radiology . 2000;  215 395-401
  • 83 Ikeda S, Sera Y, Ohshiro H. Gallbladder contraction in biliary atresia: a pitfall of ultrasound diagnosis.  Pediatr Radiol . 1998;  28 451-453
  • 84 Kim W S, Kim I O, Yeon K M, Park K W, Seo K G, Kim C H. Choledochal cyst with or without biliary atresia in neonates and young infants: US differentiation.  Radiology . 1998;  209 465-469
  • 85 Weinberger E, Blumhagen J D, Odell J M. Gallbladder contraction in biliary atresia.  AJR . 1987;  149 401-402
  • 86 Abramson S J, Berdon W E, Altman R P, Amodio J B, Levy J. Biliary atresia and noncardiac polysplenic syndrome: US and surgical considerations.  Radiology . 1987;  163 377-379
  • 87 Guibaud L, Lachaud A, Touraine R. MR cholangiography in neonates and infants: feasibility and preliminary applications.  AJR . 1998;  170 27-31
  • 88 Jaw T-S, Kuo Y-T, Liu G-C, Chen S-H, Wang C-K. MR cholangiography in the evaluation of neonatal cholestasis.  Radiology . 1999;  212 249-256
  • 89 Kim O H, Chung H J, Choi B G. Imaging of the choledochal cyst.  RadioGraphics . 1995;  15 69-88
  • 90 Savader S J, Benenati J F, Venbrux A C. Choledochal cysts: classification and cholangiographic appearance.  AJR . 1991;  156 327-331
  • 91 Torrisi J M, Haller J O, Velcek F T. Choledochal cyst and biliary atresia in the neonate: imaging findings in five cases.  AJR . 1990;  155 1273-1276
  • 92 Miller T T, Palestro C J, Groisman G M, Norton K I, Dolgin S. Choledochal cyst preoperative sonographic and scintigraphic assessment.  Clin Nucl Med . 1993;  18 1001-1002
  • 93 Irie H, Honda J, Jimi M. Value of MR cholangiopancreatography in evaluating choledochal cysts.  AJR . 1998;  171 1381-1385
  • 94 Haller J O, Conden V R, Berdon W E. Spontaneous perforation of the common bile duct in children.  Radiology . 1989;  172 621-624
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