Cheon J E, Kim W S, Kim I O, Jang J J, Seo J K, Yeon K M
Department of Radiology and the Institute of Radiation Medicine, College of Medicine, Seoul National University, Seoul, Korea.
Pediatr Radiol. 1998 Nov;28(11):878-83. doi: 10.1007/s002470050487.
Focal nodular hyperplasia (FNH) is an unusual hepatic tumour in children and should be distinguished from other hepatic lesions.
To describe the imaging characteristics of FNH in children.
We examined five patients (three boys and two girls, mean age 9.4 years) with pathologically confirmed FNH. The diagnosis was obtained by tumour resection (n = 4) and percutaneous needle biopsy (n = 1). One patient with multiple FNHs showed recurrent lesions after tumour resection. All patients were studied with US (including colour and power Doppler US [n = 3]) and CT. Dynamic enhanced CT scans were available in three patients. MRI (n = 2) or coeliac angiography (n = 1) was performed in three patients.
Seven of eight FNH lesions in five patients were demonstrated by imaging. The average size of the lesions was 6.5 cm. Six lesions detected on US showed variable echogenicity with a central hyperechoic scar (n = 2). On Doppler examination, central or peripheral hypervascular areas were seen (n = 3). Six lesions detected on contrast-enhanced CT showed high attenuation (n = 4) or iso-attenuation (n = 2). On early phase scans, all the lesions (n = 3) showed high attenuation. Irregular linear or ovoid central scars were detected in two patients on CT. MR demonstrated three lesions in two patients, one of which had not been detected by US or CT. A central low signal intensity scar (n = 1) was seen on T2-weighted MRI. Coeliac angiography performed in one patient showed a hypervascular mass with homogeneous staining.
FNH in children shows a wide spectrum of imaging findings on various radiological examinations and the typical central scar was not always seen on imaging studies. Dynamic enhanced CT obtained in the early phase and colour Doppler studies may be helpful in the diagnosis of FNH by allowing characterisation of tumour vascularity. FNH should be included in the differential diagnosis of liver mass in children.
局灶性结节性增生（FNH）是儿童中一种少见的肝脏肿瘤，应与其他肝脏病变相鉴别。
描述儿童FNH的影像学特征。
我们检查了5例经病理证实为FNH的患者（3例男孩，2例女孩，平均年龄9.4岁）。诊断通过肿瘤切除（n = 4）和经皮穿刺活检（n = 1）获得。1例患有多发FNH的患者在肿瘤切除后出现复发病变。所有患者均接受了超声检查（包括彩色和能量多普勒超声[n = 3]）和CT检查。3例患者进行了动态增强CT扫描。3例患者进行了MRI检查（n = 2）或腹腔动脉造影检查（n = 1）。
5例患者的8个FNH病变中有7个通过影像学检查显示。病变的平均大小为6.5 cm。超声检查发现的6个病变表现为回声不均，有中央高回声瘢痕（n = 2）。在多普勒检查中，可见中央或周边高血供区域（n = 3）。增强CT检查发现的6个病变表现为高密度（n = 4）或等密度（n = 2）。在早期扫描中，所有病变（n = 3）均表现为高密度。CT检查发现2例患者有不规则线性或椭圆形中央瘢痕。MRI检查在2例患者中发现3个病变，其中1个病变未被超声或CT发现。在T2加权MRI上可见1个中央低信号强度瘢痕（n = 1）。1例患者进行的腹腔动脉造影显示为高血供肿块，染色均匀。
儿童FNH在各种影像学检查中表现出广泛的影像学表现，典型的中央瘢痕在影像学研究中并非总是可见。早期进行的动态增强CT和彩色多普勒检查通过显示肿瘤血管特征可能有助于FNH的诊断。FNH应列入儿童肝脏肿块的鉴别诊断中。
