Differential diagnosis of pediatric focal liver lesions should be based on age, underlying history, and AFP level. Children vary significantly in age, size, ability to stay still, and ability to breath-hold. Choosing and tailoring imaging techniques for each indication and age group is important. The need for sedation can be obviated using techniques like feed and bundle, contrast-enhanced ultrasound, and motion-insensitive sequences for MRI. Hepatobiliary contrast media enables detection of satellite lesions and helps radiologists to refine their differential diagnosis.

Introduction (overview of liver lesions, incidence, role of imaging) Imaging modalities (specific roles, pros/cons, with summary tables) Contrast media (comparison of US, CT and MRI contrast agents) Indication-based approach for selection of imaging -Neonate with focal liver lesion (likely differentials; US, followed by feed and bundle MRI, discussion on GBCM in neonates, MRI technique) -Small child with focal liver lesion (likely differentials; US/CEUS, CT vs MRI, under sedation/GA, MRI technique) -Older child with liver lesion (likely differentials; US/CEUS, ability to stay still and hold breath, MRI technique) -Child with chronic liver disease (screening for liver lesions) -Child with Fontan (screening/characterization of liver lesions) -Child with febrile neutropenia (detection/characterization of liver lesions) -Child with renal failure and focal liver lesion (imaging/contrast options and considerations) Summary