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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(04): 612-619
DOI: 10.1055/s-0044-1785208
Original Article

Can Dynamic Contrast-Enhanced MRI Be Used to Differentiate Hepatic Hemangioma from Other Lesions in Early Infancy?

Dan Halevy
1   Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
,
Blayne A. Sayed
3   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
4   Department of Surgery, University of Toronto, Toronto, Ontario, Canada
,
Furqan Shaikh
5   Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
6   Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
,
Iram Siddiqui
6   Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
7   Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Govind B. Chavhan
1   Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations Funding None.
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Abstract

Background Confident diagnosis of hepatic hemangioma on imaging can avoid biopsy in early infancy and helps guide conservative management.

Purpose This article aims to determine if dynamic contrast-enhanced magnetic resonance imaging (MRI) can be used to differentiate liver hemangioma from other lesions in infants ≤ 100 days and to determine association of MRI features with hepatic lesions.

Methods MRI performed for liver lesions were retrospectively reviewed to note imaging characteristics and the MRI diagnosis. Final diagnosis was assigned based on pathology in available cases and by corroborative standard of reference including overall clinical features, lab findings, and follow-up.

Results Of 30 infants (18 boys, 12 girls; average age 42.2 days) included, 18 had solitary and 12 had multifocal lesions. Diagnoses in total 33 lesions included hemangiomas (23), hepatoblastoma (6), arteriovenous malformation (2), neuroblastoma metastases (1), and infarction (1). MRI and final diagnosis matched in 94% lesions with almost perfect agreement (kappa 0.86) for reader 1, and matched in 88% lesions with substantial agreement (kappa 0.71) for reader 2. Interobserver agreement for MRI diagnosis was substantial (kappa 0.62). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI in differentiating hemangioma from other lesions were 100, 90, 96, 100, and 97%, respectively. Centripetal (16/23) or flash (5/23) filling were only seen with hemangioma. There was no significant difference in alpha-fetoprotein elevation (p 0.08), average size (p 0.35), multifocality (p 0.38), and intralesional hemorrhage (p 1) between hemangioma and hepatoblastoma.

Conclusion Centripetal filling on dynamic imaging and absence of washout are characteristic MRI features of hepatic hemangioma that can help to differentiate it from other lesions in early infancy.

Keywords

liver - neonate - infants - hemangioma - hepatoblastoma - imaging

Note

This study was presented as an abstract during International Pediatric Radiology Meeting 2021, Rome, Italy.




Publication History

Article published online:
21 April 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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