INTERESTING IMAGE Incremental Diagnostic Value of F-18 FDG PET/CT Over MRI in a Pediatric Patient With Suspected Hepatoblastoma and Histologic Diagnosis of Focal Nodular Hyperplasia Francesco Bertagna, MD,* Emanuela Orlando, MD,† Giovanni Bosio, MD,* Luisa Bercich, MD,‡ Simona Fisogni, MD,‡ Luigi Grazioli, MD,† and Raffaele Giubbini, MD§ Abstract: Hepatoblastoma (HB) is the most common pediatric liver cancer representing 1% of all pediatric malignances and occurring mostly within 5 years of age. Liver recurrences and secondary lesions (abdomen, lung, and brain) can occur. Surgery and chemotherapy are widely accepted. Focal nodular hyperplasia (FNH) is a benign, usually asymptomatic, and incidental hepatic tumor with an unclear etiology, good prognosis, and its clinic management should be conservative. FNH could be evaluated by ultrasonog- raphy, computed tomography, and magnetic resonance imaging. Nuclear medicine procedures do not have an effective role in evaluating HB/FNH but F-18 FDG PET/CT represents a new option. We report a case of a child with a lesion suspect for HB at magnetic resonance imaging and negative F-18 FDG PET/CT with histologic diagnosis of FNH after resection. Key Words: hepatoblastoma, focal nodular hyperplasia, MRI, F-18 FDG PET/CT (Clin Nucl Med 2011;36: 305–308) REFERENCES 1. Grazioli L, Morana G, Kirchin MA, et al. Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-en- hanced MR imaging: prospective study. Radiology. 2005;236:166 –177. 2. Zech CJ, Grazioli L, Breuer J, et al. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA- enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol. 2008;43:504 –511. 3. Sironi S, Messa C, Cistaro A, et al. Recurrent hepatoblastoma in orthotopic transplanted liver: detection with FDG positron emission tomography. Am J Roentgenol. 2004;182:1214 –1216. 4. Philip I, Shun A, McCowage G, et al. Positron emission tomography in recurrent hepatoblastoma. Pediatr Surg Int. 2005;21:341–345. 5. Mody RJ, Pohlen JA, Malde S, et al. FDG PET for the study of primary hepatic malignancies in children. Pediatr Blood Cancer. 2006;47:51–55. 6. Kurtaran A, Becherer A, Pfeffel F, et al. 18F-fluorodeoxyglucose (FDG)-PET features of focal nodular hyperplasia (FNH) of the liver. Liver. 2000;20:487– 490. 7. Magini G, Farsad M, Frigerio M, et al. C-11 acetate does not enhance usefulness of F-18 FDG PET/CT in differentiating between focal nodular hyperplasia and hepatic adenoma. Clin Nucl Med. 2009;34:659 – 665. 8. Huo L, Wu Z, Zhuang H, et al. Dual time point C-11 acetate PET imaging can potentially distinguish focal nodular hyperplasia from primary hepatocellular carcinoma. Clin Nucl Med. 2009;34:874 – 877. Received for publication May 13, 2010; revision accepted July 28, 2010. From the *Nuclear Medicine Unit, Spedali Civili Brescia, Brescia, Italy; †First Division of Radiology, Spedali Civili Brescia, Brescia, Italy; and Departments of ‡Pathological Anatomy and §Chair of Nuclear Medicine, University of Brescia, Brescia, Italy. Reprints: Francesco Bertagna, MD, Department of Nuclear Medicine, Spedali Civili di Brescia, Piazza Spedali Civili, 1, 25123 Brescia, Italy. E-mail: francesco.bertagna@spedalicivili.brescia.it. Copyright © 2011 by Lippincott Williams & Wilkins ISSN: 0363-9762/11/3604-0305 Clinical Nuclear Medicine • Volume 36, Number 4, April 2011 www.nuclearmed.com | 305