2024 Friday Quiz 6 Answer | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

2024 Friday Quiz 6 Answer

Findings

Axial T2 weighted (image 1), coronal T2 weighted (image 2), axial T1 post contrast in the portal venous phase of imaging (image 3) and coronal postcontrast in the hepatobiliary phase of imaging (image 4) show the large mass (arrow) of the right hepatic lobe. In addition, there is thrombosis of the inferior vena cava (arrowhead) and portal vein (more posterior arrow on image 3). Hepatoblastoma is the most common hepatic malignancy of childhood. It is associated with prematurity and syndrome such as Beckwith Weidman syndrome or familial adenomatous polyposis. Hepatoblastoma is staged using the pretext system.

Additional Cases

Axial T2-weighted (image 1) and noncontrast CT (image 2) in a child with known hepatoblastoma show a large metastatic lesion (arrow) within the left parietal lobe. While brain metastases can occur in patients with hepatoblastoma, they are uncommon. The lungs are by far the most common site of metastasis in patients with this tumor.

Axial T2-weighted (image 1), T1-weighted (image 2), and postcontrast hepatobiliary phase (image 3) MR images of the liver in a patient with Alagille syndrome show a poorly defined area of signal abnormality (arrow) within the central portion of the liver, representing nodular regenerative hyperplasia. This pattern is common in patients with Alagille syndrome and other cholangiopathic disorders.

Axial T2-weighted MRI in a child with hepatoblastoma shows PRETEXT IV multifocal tumor (arrowheads) and extensive portal venous thrombosis (arrow). Hepatoblastoma is staged using the PRETEXT staging system...

Image description: Axial T2-weighted (image 1) and T1-weighted postcontrast MRI in the hepatic arterial (image 2) and hepatobiliary phases (image 3) show a large central hepatic mass (arrow). The lesion is heterogeneous on T2-weighted imaging with a wispy hyperintense internal scar...

Teaching Point

Focal nodular hyperplasia is a benign hyperplastic lesion that arises in response to anomalous arterial supply. On angiography, it classically demonstrates a central feeding artery with radiating spoke-wheel–like arterial branches, corresponding to the fibrous central scar and abnormal intralesional arteries.