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
