Outcome of Prenatally Diagnosed Fetal Liver Lesions: Implications for Prenatal Management

INTRODUCTION: The aim of this study was to evaluate the diagnostic yield of prenatal imaging for fetal liver lesions and to characterize associated postnatal outcomes. METHODS: We conducted a single-center retrospective review of prenatally diagnosed liver lesions between 2013 and 2023. Data collected included prenatal imaging findings, postnatal diagnoses, neonatal outcomes, and management strategies. RESULTS: Thirty women were referred at a median gestational age (GA) of 31.1 weeks [IQR: 27.5-33.4]. Lesions were classified as cystic (53%), solid (20%), mixed (17%), or vascular (10%). Postnatal diagnoses included hemangioma (33%), hepatic cyst (27%), choledochal cyst (10%), arteriovenous malformation or portosystemic shunt (13%), mesenchymal hamartoma (7%), biliary atresia (3%), focal nodular hyperplasia (3%), and unknown (6%). Overall diagnostic concordance between prenatal and postnatal findings was 69%. Fetal complications occurred in 40% of cases, most commonly cardiac overload (n = 8), intrauterine growth restriction (n = 3), and mass effect (n = 2). Hypervascularized lesions were significantly associated with fetal compromise (p < 0.001). No cases of intrauterine fetal demise were observed. Fetal MRI was performed in 70% of cases and improved diagnostic accuracy in two cases. Median GA at delivery was 38.0 weeks [IQR: 36.6-39.1]. Postnatal management included expectant observation (67%), surgery (20%), β-blockers (7%), and embolization (3%). After a median follow-up of 32.5 months [IQR: 14.8-60.9], 38% of lesions had regressed spontaneously. One infant died from complications following embolization. CONCLUSION: Most fetal liver lesions are associated with favorable outcomes. However, hypervascularized lesions are predictive of in utero complications and warrant close monitoring. Fetal MRI may improve diagnostic accuracy and guide postnatal management.