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Incidental Liver Lesions in children: A practical and evidence-based approach

Incidental liver lesions are increasingly being discovered in the context of the increased use of ultrasound studies and the majority are benign. In children, although individually rare, the differential diagnosis is broad and therefore a systematic approach is of utmost importance to reduce the radiological and disease burden in children and their families. This review article collected current evidence and provides fundamental information for the clinician regarding specific differential diagnoses and unique imaging features of benign liver lesions in children. Ultimately, we propose a practical stepwise approach mainly involving clinical and radiological workup. Laboratory tests and histopathological examination may be necessary in the presence of red flags or in indeterminate lesions.

Diagnostic Performance of 2-D Shear Wave Elastography for Differentiation of Hepatoblastoma and Hepatic Hemangioma in Children under 3 Years of Age

The aim of the present study was to prospectively evaluate the clinical efficiency of 2-D shear wave elastography (2-D-SWE) for differentiating hepatoblastoma and hepatic hemangioma in children under 3 y of age. 2-D-SWE was performed in 109 consecutive patients with confirmed hepatic neoplasms by pathologic analysis or contrast-enhanced computed tomography plus follow-up observation, in which 71 patients were defined as the test group, and the remaining 38 patients were defined as the validation group. An elasticity value was obtained from each lesion. The diagnostic performance and optimal cut-off value were determined by receiver operating characteristic (ROC) analysis in the test group, and the accuracy of this threshold was analyzed in the validation group. The interclass correlation coefficient (ICC) and Spearman rank correlation tests were applied to assess the reproducibility of elastic measurement and the relationship between the elasticity value and potential influencing parameters. The mean elasticity values were 58.4 ± 19.5 kPa for hepatoblastoma and 19.0 ± 16.0 kPa for hemangioma (Z = -7.685, p = 0.000). The cut-off value in the test group was 39.5 kPa with an area under the ROC curve for differentiation of 0.915, sensitivity of 88.1% and specificity of 86.2%. The accuracy of this threshold in the validation group was 86.8%. The ICCs for inter- and intra-observer reproducibility for acquisition of the elastic measurement were 0.946 and 0.971, respectively. No significant correlation was found between the elasticity value and age for either hemangioma (r = 0.205, p = 0.167) or hepatoblastoma (r = 0.047, p = 0.715). The elasticity value was positively correlated with lesion size (r = 0.332, p = 0.023) in patients with hemangioma but not in patients with hepatoblastoma (r = 0.222, p = 0.082). As a complementary method, 2-D-SWE may aid the differentiation of hepatoblastoma and hemangioma.