MRI features of hepatocellular adenomas in children: clinical and radiological review.

Abstract

Background: Hepatocellular adenomas (HCAs) are rare, benign hepatic tumors in children, with limited imaging data available for pediatric cases.

Objective: To describe the magnetic resonance imaging (MRI) and clinical features of histologically proven HCAs in children.

Materials and methods: 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.

Results: 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.

Conclusion: 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.