Imaging insights into pediatric liver masses: A comprehensive minireview for hepatology practice

Table 3 Summary of pediatric hepatic masses in children six years of age and older

	Age	Gender	Alpha-fetoprotein	Imaging appearance	Quantitative metrics
Hepatocellular carcinoma	> 6 years of age (bimodal peak: 10-14 years)	No gender predilection	Elevated in 50%-70% (variable; can be > 10000 ng/mL)	US: Heterogeneous mass, may show necrosis. CT/MRI: Arterial phase enhancing lesion with washout on portal/delayed phases	Size: > 5 cm at presentation. Occasional calcifications (approximately 20%). Risk factors: Chronic liver disease, metabolic disorders (e.g., tyrosinemia)
Focal nodular hyperplasia	> 6 years (mean age of 12 years)	More common in females	Normal	US: Isoechoic to hypoechoic; spoke wheel pattern of vascularity. CT and MRI: Enhancing lesion with central scar. T2 hyperintense scar, arterial enhancement with delayed central scar fill-in	Size: < 5 cm. Central scar: Present in approximately 80%. Calcification is rare
Hepatic adenoma	> 6 years (mean age of 12 years)	More common in females	Normal	US: Solid, hyperechoic or isoechoic. CT: Arterial enhancement, isoechoic/hypodense in venous phase. MRI: Variable T1/T2, early enhancement, no central scar. May show fat or hemorrhage	Size: Variable; > 5 cm increases risk of hemorrhage. Risk of rupture/malignant transformation in β-catenin-mutated subtype. Risk factors: Oral contraceptive pills or steroid use

CT: Computed tomography; MRI: Magnetic resonance imaging; US: Ultrasound.