The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Imaging Features of Hepatocellular Carcinoma in Children With and Without Underlying Risk Factors
AJR Am J Roentgenol. 2022 Oct;219(4):647-654. doi: 10.2214/AJR.22.27600. Epub 2022 May 11.
1Department of Radiology, Nationwide Children's Hospital, ED Bldg, 4th Fl, 700 Childrens Dr, Columbus, OH 43205.
2Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
3Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
4Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
5Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH.
6Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
7Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA.
8Department of Radiology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
9Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO.
10Department of Pediatrics, Biostatistics Core, Emory University, Atlanta, GA.
11Present affiliation: General Dynamics Information Technology, Falls Church, VA.
Abstract
BACKGROUND. Pediatric hepatocellular carcinoma (HCC) is an aggressive malignancy for which imaging findings remain poorly described. In comparison with adult HCC, pediatric HCC more commonly occurs without underlying risk factors, and standardized surveillance guidelines for those with predispositions are lacking. OBJECTIVE. The purpose of this article was to evaluate imaging findings of nonfibrolamellar pediatric HCC and to identify associations between these imaging findings and the presence of predisposing factors. METHODS. This retrospective study included children (≤ 18 years) with histologically confirmed nonfibrolamellar HCC who underwent multiphase CT or MRI at one of four academic children's hospitals between July 2009 and April 2019. Surveillance regimens in children with predispositions were at the discretion of treating physicians. Clinical characteristics were recorded. Scan indications were classified as surveillance versus clinical signs and symptoms. Images from all sites were submitted to a cloud-based server. Two radiologists independently assessed imaging features of HCC, including tumor size, tumor in vein, Pre-Treatment Extent of Tumor (PRETEXT) stage, and LI-RADS major features of adult HCC. Imaging findings were compared between patients with and without predispositions. RESULTS.The study included 39 patients: 17 with predispositions (mean age, 10.5 ± 4.5 years; nine boys, eight girls) and 22 without predispositions (mean age, 11.3 ± 5.1 years; 12 boys, 10 girls). Scan indication was surveillance in 14/17 patients with predispositions versus 0/22 patients without predispositions (p < .001). Patients with versus those without predispositions had smaller tumor size (reader 1: 6.0 vs 11.9 cm [p = .003]; reader 2: 6.0 vs 12.9 cm [p < .001]) and less frequent tumor in vein (reader 1: 0% vs 41% [p = .002]; reader 2: 0% vs 36% [p = .006]). PRETEXT stage IV disease was observed in 18% (both readers) of patients with predispositions versus 50-55% of patients without predispositions. No LI-RADS major feature of adult HCC showed a significant difference in frequency between patients with and without predispositions for either reader (all p > .05). CONCLUSION. Among children with HCC, those with predispositions exhibited smaller and lower-stage tumors and less frequent tumor in vein, likely because of surveillance imaging. CLINICAL IMPACT. The study supports the role of routine surveillance imaging in children with HCC predispositions to facilitate earlier detection. Standardization of surveillance guidelines remains needed.