B Karmazyn et al. JPGN 2022; 74: 320-327. Diagnosis and Follow-up of Incidental Liver Lesions in Children

This article summarizes the authors’ diagnostic approach to incidental liver lesions. Figure 1 provides provides an overview. The authors note that an MRI is preferred for multiple lesions, complex cysts, and solid cysts >3 cm in size. This algorithm recommends the following:

• Consideration of liver biopsy for lesions 5 cm or greater (though imaging surveillance can be considered for some lesions with typical benign appearance). Most malignant lesions are >5 cm.
• For those lesions less than 5 cm, in those with features of hepatocellular adenoma or lesions with atypical features, consider a biopsy if feasible
• For those lesions less than 5 cm, in those with a typical appearance of a simple cyst, hemangioma or focal nodular hyperplasia, the algorithm recommends surveillance every 6-12 months. When a lesion is stable in size, surveillance can be changed to every 2-3 years. In those lesions that are increasing size, either a biopsy or more frequent surveillance (every 3-6 months) is recommended.
• In terms of modality, if initial imaging is an ultrasound, the algorithm recommends an MRI if the lesion is a complex cyst, and for solid lesions >3 cm. No followup is recommended for “typical focal fatty infiltration or sparing.”

Related blog post: Liver Masses -Helpful Reference

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