Almushayqih Musab, Chami Rose, Rutten Caroline, Malik Aleena, Chavhan Govind B
Diagnostic and Interventional Radiology Department, Hospital for Sick Children, 555 University Ave, Toronto M5G 1X8, Toronto, Canada.
Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Pediatr Radiol. 2025 Mar;55(3):488-498. doi: 10.1007/s00247-025-06177-7. Epub 2025 Jan 31.
Hepatocellular adenomas (HCAs) are rare, benign hepatic tumors in children, with limited imaging data available for pediatric cases.
To describe the magnetic resonance imaging (MRI) and clinical features of histologically proven HCAs in children.
Single-center retrospective review of pathology-proven HCA from January 2004 to February 2024. Patients with available pre-intervention imaging in our PACS were included. Two independent readers reviewed the imaging studies. The features were summarized using descriptive statistics and inter-reader agreement was assessed using Cohen's kappa.
This study included 11 children (6 boys and 5 girls; median age 15 years) with 13 pathologically proven HCAs. Three patients had type 1a glycogen storage disease. Five patients had a single lesion, while six had multiple lesions. The lesions were well-defined with a median average diameter of 3.6 cm. Most were homogenously T1 iso-intense (61.5%) and mildly hyperintense (76.9%) on T2-w fat saturated images. The atoll sign was present in two lesions. Intralesional fat was observed in 69.2% of cases: microscopic in eight lesions and macroscopic in one. Hemorrhage occurred in three (23.07%) lesions and necrosis in one (7.7%). Nine out of 10 (90%) lesions showed arterial phase hyperenhancement, and only 3/10 (30%) lesions retained contrast on hepatobiliary phase. In total, 6/13 (46.1%) lesions showed washout, and all received hepatobiliary agent. One lesion ruptured with the hemoperitoneum. Of the 11, 63.6% of patients underwent percutaneous biopsy and 36.4% underwent surgical resection.
MR imaging features are nonspecific, but homogenous slight T2 hyperintensity, arterial phase hyperenhancement, and intralesional fat content are common features. Hepatobiliary contrast uptake is variable.
肝细胞腺瘤（HCA）是儿童罕见的良性肝脏肿瘤，儿科病例的影像学数据有限。
描述经组织学证实的儿童HCA的磁共振成像（MRI）及临床特征。
对2004年1月至2024年2月间经病理证实的HCA进行单中心回顾性研究。纳入在我院PACS系统中有术前影像资料的患者。由两名独立阅片者对影像研究进行评估。采用描述性统计方法总结特征，并使用Cohen's kappa评估阅片者间的一致性。
本研究纳入11例儿童（6例男孩，5例女孩；中位年龄15岁），共13个经病理证实的HCA。3例患者患有1a型糖原贮积病。5例患者为单个病灶，6例为多个病灶。病灶边界清晰，中位平均直径为3.6 cm。多数病灶在T1加权像上呈等信号（61.5%），在T2加权脂肪抑制像上呈轻度高信号（76.9%）。2个病灶出现“环岛征”。69.2%的病例观察到瘤内脂肪：8个病灶为镜下脂肪，1个病灶为肉眼脂肪。3个病灶（23.07%）发生出血，1个病灶（7.7%）发生坏死。10个病灶中有9个（90%）在动脉期呈高强化，仅3/10（30%）的病灶在肝胆期有造影剂滞留。总共6/13（46.1%）的病灶出现廓清，所有病灶均接受了肝胆对比剂检查。1个病灶破裂并伴有腹腔积血。11例患者中，63.6%接受了经皮活检，36.4%接受了手术切除。
MR成像特征不具有特异性，但均匀性轻度T2高信号、动脉期高强化及瘤内脂肪含量是常见特征。肝胆期对比剂摄取情况不一。
