Pediatric primary liver tumors, including hepatoblastoma and hepatocellular carcinoma (HCC), are staged according to the PRETEXT system (PRE-Treatment EXTent of Tumor). Although primary hepatic tumors are rare in the pediatric population, hepatoblastoma is increasing in prevalence due to its association with prematurity and the prolonged survival of this patient population. Therefore, it is prudent for radiologists to refamiliarize themselves with these malignancies and how to accurately describe their imaging appearance using descriptors defined by PRETEXT. Various imaging modalities offer a role in the evaluation of primary hepatic tumors, including ultrasound (US), magnetic resonance (MR), and computed tomography (CT). Contrast enhanced ultrasound (CEUS) is not currently a primary modality but has potential to evaluate vascular involvement and satellite lesions. PRETEXT is the standard to describe a tumor’s imaging features on CT or MR; MR is preferred due to improved soft tissue detail, and emphasis is placed on use of a hepatobiliary contrast agent. For PRETEXT staging, the liver is divided into four sections: right posterior, right anterior, left medial, and left lateral. Depending on the number of continuous, uninvolved sections, patients are assigned a group ranging from I-IV. Tumors are often large at presentation, and determination of anatomic boundaries can be challenging for the radiologist. Other special circumstances discussed include variant hepatic venous anatomy and pedunculated tumors. PRETEXT also considers “annotation factors”, such as vascular involvement, tumor rupture, and metastases, among others. In combination with clinical factors, such as the patient's age and alpha-fetoprotein (AFP) level, PRETEXT is also used to stratify patient risk and ultimately influence patient management. If the tumor is not resectable upfront, percutaneous biopsy is recommended to confirm the diagnosis. First line therapy includes surgical resection and systemic chemotherapy. In cases not amenable to this treatment, palliative options offered by pediatric interventional radiology include transarterial chemoembolization (TACE) and percutaneous ablation. The goal of this educational exhibit is to provide a case-based illustration of PRETEXT staging and annotations factors for the pediatric radiologist. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Lee Samantha, Cajigas-loyola Stephanie, Acord Michael

Keywords: PRETEXT, Primary Hepatic Tumor, Staging

Implantable Venous Access Devices (IVAD) play an important role in medical treatment and comfort to pediatric patients requiring long term intravenous therapy. Traditionally, 2 small surgical skin incisions are utilized in the procedure, one in the neck for jugular venous access and the other in the chest wall to create a subcutaneous pocket for the IVAD reservoir. The authors describe an innovative technique, where a long-curved needle and curved guidewire are utilized to obtain internal jugular vein access through a single chest wall incision for both vascular access and the IVAD reservoir. The subcutaneous tract and the venous access sites are serially dilated and the IVAD is placed over the wire. This technique avoids the incision placed at the neck. This modification has multiple potential advantages, as it avoids a second incision in at risk patients (tracheostomy, anasarca, cervical instability), potential better cosmetic outcome and potentially lower risk of infection,. The purpose of this educational abstract is to demonstrate this innovative minimally invasive technique of placing IVAD in pediatric population. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Tabor Biniyam Beyene, Kinariwala Dhara, Schoeman Sean, Cajigas-loyola Stephanie, Escobar Fernando, Cahill Anne Marie, Vatsky Seth, Srinivasan Abhay, Krishnamurthy Ganesh

Keywords: Vascular Access