Image‐Guided Biopsy for the Diagnosis and Molecular Profiling of Hepatoblastoma

Pediatric Blood & Cancer · 2025-02-04 · 1 citations

INTRODUCTION: Studies on the use of image-guided percutaneous biopsy for hepatoblastoma (HB), and recommendations put forth by the pediatric hepatic international tumor trial (PHITT), are limited. It is unknown if sufficient tissue can be obtained for trial enrollment as well as molecular profiling, which will likely play a key role in informing future treatment strategies. METHODS AND MATERIALS: Patients with HB who underwent percutaneous biopsy at initial diagnosis in interventional radiology (IR) over a 12-year period at a single center were included. Patient demographics, pretreatment extent of disease (PRETEXT) stage, tumor size, and procedure details were collected. Pathology reports and tumor genomic analysis, when performed, were assessed for specimen adequacy. Post-procedure records were assessed for hemoperitoneum. RESULTS: A total of 33 percutaneous biopsies were performed on 32 patients [17 female; median age 1.3 years (IQR: 0.7-2.5 years); median weight 10.5 kg (IQR: 7.4-12.7 kg)]. Most (n = 27) had a single liver lesion, and most (n = 18) were PRETEXT II. A total of 15 were positive for at least one annotation factor. Median longest tumor axis was 9.3 cm (IQR: 5.0-13.5 cm). A total of 16 patients had concurrent non-targeted liver biopsy, per PHITT recommendations. An 18-gauge instrument was most commonly used (n = 24, 73%) with a median of 8 cores (IQR: 6-12) obtained. There were no instances of hemoperitoneum. Tissue was adequate for histologic diagnosis in 97% (n = 32), with histologic subtyping obtained in 94% (30/32). When available (n = 29), comparison with the subsequent surgical resection specimen showed subtype concordance in 15 (52%) patients and minor variations secondary to sampling or treatment effect in 14 patients. Molecular profiling was completed on 21/21 specimens (100%), with 19/21 (90%) showing potentially clinically significant variants, most commonly in CTNNB1 (16/21). CONCLUSION: In this single-center study, percutaneous biopsy resulted in no serious adverse events, a high rate of diagnosis, and successful subtyping and molecular characterization of HB.

ChatGPT-4–Driven Liver Ultrasound Radiomics Analysis: Diagnostic Value and Drawbacks in a Comparative Study

JMIR AI · 2025-05-19 · 2 citations

BACKGROUND: Artificial intelligence (AI) is transforming medical imaging, with large language models such as ChatGPT-4 emerging as potential tools for automated image interpretation. While AI-driven radiomics has shown promise in diagnostic imaging, the efficacy of ChatGPT-4 in liver ultrasound analysis remains largely unexamined. OBJECTIVE: This study aimed to evaluate the capability of ChatGPT-4 in liver ultrasound radiomics, specifically its ability to differentiate fibrosis, steatosis, and normal liver tissue, compared with conventional image analysis software. METHODS: Seventy grayscale ultrasound images from a preclinical liver disease model, including fibrosis (n=31), fatty liver (n=18), and normal liver (n=21), were analyzed. ChatGPT-4 extracted texture features, which were compared with those obtained using interactive data language (IDL), a traditional image analysis software. One-way ANOVA was used to identify statistically significant features differentiating liver conditions, and logistic regression models were used to assess diagnostic performance. RESULTS: -score (0.85). When combined, ChatGPT-4 attained 76% accuracy and 83% sensitivity in classifying liver disease. Receiver operating characteristic analysis demonstrated strong discriminatory performance, with area under the curve values of 0.75 for fibrosis, 0.87 for normal liver, and 0.97 for steatosis. Compared with IDL image analysis software, ChatGPT-4 exhibited slightly lower sensitivity (0.83 vs 0.89) but showed moderate correlation (r=0.68, P<.001) with IDL-derived features. However, it significantly outperformed IDL in processing efficiency, reducing analysis time by 40%, and highlighting its potential for high throughput radiomic analysis. CONCLUSIONS: Despite slightly lower sensitivity than IDL, ChatGPT-4 demonstrated high feasibility for ultrasound radiomics, offering faster processing, high-throughput analysis, and automated multi-image evaluation. These findings support its potential integration into AI-driven imaging workflows, with further refinements needed to enhance feature reproducibility and diagnostic accuracy.

Portal Vein Obstruction in Pediatric Liver Transplant Patients: An Evaluation of Self‐Reported Management Practices

Health Science Reports · 2025-05-01

Background and Aims: Portal vein obstruction (PVO) is a known complication after pediatric liver transplantation (pLT). Effective management strategies are crucial in improving patient outcomes. This study investigated the various practice patterns related to PVO management to clarify the degree of consensus on the diverse facets of care involved in addressing PVO after pLT. Methods: A self-reported evaluation was conducted using a scanned, paper-based survey among specialized pLT centers participating in the Portal vein Obstruction Revascularization Therapy After Liver transplantation (PORTAL) registry. The survey consisted of 30 questions covering the current practices regarding PVO, including experience, team composition, follow-up and screening protocol, assessment criteria, postprocedural care, and radiologic follow-up. Results: The survey was returned by 25 centers (100%) from different regions worldwide. All centers used Doppler ultrasound (DUS) for PVO screening in the outpatient department. Noninvasive diagnostic criteria used during DUS assessment included anastomotic velocity (50%) and anastomotic-to-pre-anastomotic velocity ratio (54%). Digital subtraction angiography was used by 79% of respondents to diagnose portal vein anastomosis stenosis, which led to diagnostic cutoff values including a narrowing of the visual aspect of the anastomosis of ≥ 50% (80%) and a pressure gradient ≥ 5 mmHg (50%). PTA was identified as a standard treatment for PVO. A remarkable heterogeneity was observed in postinterventional anticoagulation and surveillance protocols. Conclusions: NL9261.

Benign and Malignant Pediatric Liver Masses: Radiologic-Pathologic Update from the Pediatric LI-RADS Working Group

Radiographics · 2025-10-23

Benign and malignant primary pediatric liver tumors are reviewed, correlating imaging features with the underlying pathology and incorporating updates in imaging technology and tumor classification.

SPNing our wheels—Pancreatic solid pseudopapillary neoplasm as an extraluminal etiology of persistent duodenal ulceration

JPGN Reports · 2025-02-25

Pediatric upper gastrointestinal (GI) bleeding secondary to duodenal ulceration is a potentially serious and life-threatening condition with a broad differential diagnosis. We present a pediatric case of a pancreatic head solid pseudopapillary neoplasm (SPN) presenting with duodenal ulceration and recurrent upper GI bleeding. This case highlights pancreatic SPNs as a rare extrinsic cause of duodenal ulceration. Recurrence and progression in size and extent of a duodenal ulceration in the absence of other inciting factors should raise suspicion for an extraluminal etiology.

Management of hepatic artery thrombosis and stenosis after pediatric liver transplantation: Variability and agreement in management practices

Liver Transplantation · 2025-06-30 · 1 citations

Guidelines for managing hepatic artery thrombosis (HAT) and stenosis (HAS) after pediatric liver transplantation (pLT) are lacking, with heterogeneous local practices. This study aims to evaluate management practices for HAT and HAS after pLT. An online and paper-based survey was sent to 36 international pLT centers. The survey included 36 questions covering center experience, screening protocols, diagnostic criteria, preventive management, post-procedural care, and follow-up. Treatment strategies were explored through hypothetical case scenarios categorized by early (≤14 d after pLT) and late onset complications (>14 d after pLT). Responses from 36 centers showed that 60% applied interrupted sutures and 76% used a surgical loupe during transplantation. In addition, 89% followed a specific anticoagulation protocol after uncomplicated pLT. All centers initiated Doppler ultrasound (DUS) within 24 hours after pLT, with 60% conducting it daily during the first week. Immediate re-transplantation was preferred for early HAT with pediatric acute liver failure (PALF) (61% vs. 11% for non-PALF, p <0.001), and surgical revascularization was more frequently chosen for non-PALF cases (51% vs. 24% for PALF, p <0.001). Endovascular therapy was selected in 35% of cases for both late HAT and HAS, with conservative management chosen in 51% for late HAT and 61% for late HAS (all p <0.001, compared to early cases). Internationally, there is agreement on the importance of early DUS screening in current management practices. Immediate re-transplantation was preferred for early HAT with PALF, while surgical revascularization was favored for non-PALF cases. Conservative management and endovascular therapy emerged as potential strategies for late-onset cases. This worldwide survey on real-world practice provides a basis for developing and implementing guidelines.

Pediatric 3D MRCP imaging: strategies for enhancing exam quality

Abdominal Radiology · 2025-06-27

MRCP is essential for noninvasive evaluation of the biliary and pancreatic ductal systems in children but can suffer from suboptimal image quality due to inconsistent protocols and technical factors. We performed a quality improvement project focused on enhancing the image quality of 3D MRCP at a tertiary children's hospital. The project identified key contributors to poor image quality, including the inconsistent use of respiratory-triggered techniques and the absence of standardized protocols across multiple MRI units. Interventions were implemented, including updating protocols, technologist education, and improving communication between radiologists and technologists. We set a goal of achieving 90% of MRCP exams with acceptable image quality by September 2024. Our efforts increased the success rate from 68 to 77%. Although the target was not fully reached by the end of the set project timeline, the effort highlights the importance of multidisciplinary collaboration, continuous education, and ongoing auditing in driving improvements in imaging quality.

Pediatric Liver Transplant: Anatomic, Imaging, and Surgical Considerations—A Report of the Pediatric LI-RADS Working Group, From the <i>AJR</i> Special Series on Critical Anatomy

American Journal of Roentgenology · 2025-08-27

Liver transplant is the definitive treatment for children with end-stage liver disease, select metabolic disorders, and unresectable hepatic malignancies. Radiologists play a central role in the multidisciplinary transplant team, contributing to preoperative assessment, surgical planning, and postoperative surveillance. This article, a report from the Pediatric LI-RADS working group in collaboration with pediatric liver transplant surgeons, highlights the unique aspects of pediatric liver transplantation, focusing on critical anatomic, imaging, and surgical considerations specific to children. Use of the PRE-Treatment EXTent of tumor (PRETEXT) system for tumor staging is described, along with anatomic factors relevant to resectability and transplant eligibility. Particular attention is given to technical aspects of transplantation, including the frequent use of living donor and segmental grafts in pediatric recipients. Imaging protocols for both donor and recipient evaluation are reviewed, with emphasis on volumetric analysis, vascular and biliary anatomy, and identification of anatomic variants that may influence surgical decision-making. Postoperative imaging findings, including common vascular and biliary complications, are also discussed. By understanding the unique anatomic and surgical considerations in pediatric liver transplantation, radiologists can enhance diagnostic accuracy, facilitate interdisciplinary communication, and support optimal outcomes for pediatric transplant recipients.

Transradial cerebral angiography in the neonate and infant: a case series

Journal of NeuroInterventional Surgery · 2025-01-08 · 1 citations

BACKGROUND: We aim to share our experience of transradial access (TRA) for cerebral angiography and intervention in five patients ranging from 6 days to 7 months of age. METHODS: In this institutional review board-approved, retrospective case series, we reviewed all patients who underwent TRA for cerebral angiography with and without intervention. We describe three techniques for radial artery cannulation, namely: (1) bareback; (2) with a micropuncture sheath; and (3) with an intravenous catheter. Demographic, clinical, procedural, and imaging data were abstracted from the patients' medical records. RESULTS: From September 2019 to August 2023, five patients (median age and weight, 24 days (range 6-218 days) and 4.2 kg (range 3.2-6.2 kg)) underwent TRA for cerebral angiography. Four patients underwent diagnostic cerebral angiography, two via left TRA and two via right TRA. One patient was definitively treated with endovascular embolization for an arteriovenous fistula. Median procedural length was 1.5 hours (range 1-2.2 hours) and median effective skin dose was 88.7 mGy (range 48.8-140.3 mGy). No procedures required conversion to femoral artery access to obtain diagnostic quality imaging or to facilitate intervention. No complications related to the accessed radial artery were recorded. CONCLUSIONS: We have demonstrated that TRA in the neonate and infant is feasible. In our experience this technique is safe and effective for diagnostic cerebral angiography. Additionally, select intervention via TRA in this population may be possible as demonstrated by our single example of endovascular management of an intracranial fistula.

Incidence and risk factors for portal vein complications after pediatric liver transplantation: A retrospective cohort analysis from the PORTAL registry

Liver Transplantation · 2025-09-10 · 2 citations

Portal vein complications (PVCs) are recognized but infrequent complications following pediatric liver transplantation (pLT), particularly in young patients with biliary atresia (BA). However, the exact incidence of PVCs remains unclear. This study aimed to determine the overall incidence of PVCs after pLT and to explore variations within specific subgroups defined by indication for pLT, age at pLT, donor type, transplant era, and center volume. Differences between portal vein stenosis (PVS) and portal vein occlusion (PVO) were also examined. The Portal Vein Obstruction Revascularization Therapy After Liver Transplantation (PORTAL) registry, a multicenter, retrospective, observational database, collected data on PVCs from 21 pLT centers. Analysis of 6035 pLT procedures performed over a 19-year period identified 385 cases of PVCs, yielding an overall incidence of 6.3%. PVS and PVO most commonly occurred within the first year post-pLT, with PVO peaking in the first week and PVS cases distributed more evenly throughout the year. The incidence was highest following pLT for BA performed before the age of 1 year (13.0%). PVC rates increased over time, rising from 4.3% during 2001-2006 to 6.9% during 2016-2020. The highest rates of PVS and the lowest rates of PVO were observed in high-volume centers. These findings clarify the incidence of PVCs among pLT recipients and provide critical insights to improve prevention, early detection, and management strategies for these complications.