Metastases

Primary neoplasms that metastasize most frequently to the liver in the pediatric age group are Wilms' tumor, neuroblastoma, lymphoma and leukemia (Fig. 24). In contrast to liver metastases in adults, metastases to the liver in pediatric patients are much more uncommon. However, with regard to imaging studies, the same imaging characteristics are observed as in adult patients. Further details can be found in Chapter 6,"Imaging of Malignant Focal Liver Lesions", section 6.2.2, "Metastases".

Fig. 21a-h. Primary hepatic large cell lymphoma. The T2-weighted image (a) reveals a giant hyperintense, sharply demarcated mass in the right liver lobe. Displacement of the portal vein (arrow) can be seen on the true FISP image (b). The lesion is homogeneously hypointense on the unenhanced Tl-weighted image (c) and shows slight but homogeneous enhancement on Tl-weighted fat-suppressed dynamic images following the bolus injection of Gd-BOPTA (d-f). The tumor is again hypointense on Tl-weighted fat-suppressed (g), and Tl-weighted (h) images acquired during the hepatobiliary phase after injection of Gd-BOPTA. Distinct tumor margins are again depicted clearly

Fig. 21a-h. Primary hepatic large cell lymphoma. The T2-weighted image (a) reveals a giant hyperintense, sharply demarcated mass in the right liver lobe. Displacement of the portal vein (arrow) can be seen on the true FISP image (b). The lesion is homogeneously hypointense on the unenhanced Tl-weighted image (c) and shows slight but homogeneous enhancement on Tl-weighted fat-suppressed dynamic images following the bolus injection of Gd-BOPTA (d-f). The tumor is again hypointense on Tl-weighted fat-suppressed (g), and Tl-weighted (h) images acquired during the hepatobiliary phase after injection of Gd-BOPTA. Distinct tumor margins are again depicted clearly

Fig. 22a-g. Hepatic lymphoma. The diffuse lymphomatous form of non-Hodgkin's lymphoma is isointense on the unenhanced T2-weighted image (a). Dilatation of the bile ducts can be seen without depiction of an underlying mass. Conversely, T1-weighted (b) and Tl-weighted fat-suppressed (c) images reveal the presence of a distinct tumor that is hypointense compared to the normal liver parenchyma. The tumor shows homogeneous enhancement on dynamic Tl-weighted fat-suppressed images (d, e) after the injection of Gd-BOPTA. Note that veins can be seen traversing the lesion without invasion or distortion (arrows in e). The tumor is markedly hypointense with a more nodular appearance on the Tl-weighted image (f) acquired during the hepatobiliary phase after Gd-BOPTA administration. On a corresponding MRC image (g) dilatation of the bile ducts towards the liver hilum is visible

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Fig. 23a-g. Secondary periportal infiltration of the liver by a Burkitt lymphoma. The unenhanced T2-weighted single-shot HASTE images in axial (a, b) and coronal orientation (c) reveal a large, heterogeneous mass (arrows in a) infiltrating from the hilum along the portal tracts into the liver. On the unenhanced Tl-weighted fat-suppressed image (d) the lesion appears homogeneously hypointense. The lesion shows heterogeneous enhancement on dynamic phase images acquired after the administration of contrast agent (e-g). Note that encasement of the portal vessels is clearly visible (arrows in e). Note, in addition, the tumor masses surrounding the gallbladder (arrowsin g) and the infiltration of the kidneys (arrowheadsin g)

Fig. 24a-h. Liver metastases from neuroblastoma. The unenhanced T2-weighted images (a, b) reveal multiple, diffusely distributed hy-perintense lesions (arrows) throughout the liver. The lesions appear slightly hypointense on the corresponding unenhanced Tl-weighted image (c). Dynamic contrast-enhanced Tl-weighted images (d-g) acquired after the bolus injection of contrast agent reveal the hypervas-cular nature of the metastases and contrast agent pooling. On the Tl-weighted fat-suppressed image in the equilibrium phase (h) the lesions have homogeneous high SI and are clearly demarcated from surrounding liver tissue

Fig. 24a-h. Liver metastases from neuroblastoma. The unenhanced T2-weighted images (a, b) reveal multiple, diffusely distributed hy-perintense lesions (arrows) throughout the liver. The lesions appear slightly hypointense on the corresponding unenhanced Tl-weighted image (c). Dynamic contrast-enhanced Tl-weighted images (d-g) acquired after the bolus injection of contrast agent reveal the hypervas-cular nature of the metastases and contrast agent pooling. On the Tl-weighted fat-suppressed image in the equilibrium phase (h) the lesions have homogeneous high SI and are clearly demarcated from surrounding liver tissue

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