Pediatric Radiology

, Volume 48, Issue 4, pp 536–554 | Cite as

2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT)

  • Alexander J. TowbinEmail author
  • Rebecka L. Meyers
  • Helen Woodley
  • Osamu Miyazaki
  • Christopher B. Weldon
  • Bruce Morland
  • Eiso Hiyama
  • Piotr Czauderna
  • Derek J. Roebuck
  • Greg M. Tiao


Imaging is crucial in the assessment of children with a primary hepatic malignancy. Since its inception in 1992, the PRETEXT (PRE-Treatment EXTent of tumor) system has become the primary method of risk stratification for hepatoblastoma and pediatric hepatocellular carcinoma in numerous cooperative group trials across the world. The PRETEXT system is made of two components: the PRETEXT group and the annotation factors. The PRETEXT group describes the extent of tumor within the liver while the annotation factors help to describe associated features such as vascular involvement (either portal vein or hepatic vein/inferior vena cava), extrahepatic disease, multifocality, tumor rupture and metastatic disease (to both the lungs and lymph nodes). This manuscript is written by members of the Children’s Oncology Group (COG) in North America, the International Childhood Liver Tumors Strategy Group (SIOPEL) in Europe, and the Japanese Study Group for Pediatric Liver Tumor (JPLT; now part of the Japan Children’s Cancer Group) and represents an international consensus update to the 2005 PRETEXT definitions. These definitions will be used in the forthcoming Trial to Pediatric Hepatic International Tumor Trial (PHITT).


Children Computed tomography Hepatoblastoma Hepatocellular carcinoma Liver tumors Magnetic resonance imaging Staging 


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexander J. Towbin
    • 1
    Email author
  • Rebecka L. Meyers
    • 2
  • Helen Woodley
    • 3
  • Osamu Miyazaki
    • 4
  • Christopher B. Weldon
    • 5
  • Bruce Morland
    • 6
  • Eiso Hiyama
    • 7
  • Piotr Czauderna
    • 8
  • Derek J. Roebuck
    • 9
  • Greg M. Tiao
    • 10
  1. 1.Department of RadiologyCincinnati Children’s HospitalCincinnatiUSA
  2. 2.Division of Pediatric Surgery, Primary Children’s HospitalUniversity of UtahSalt Lake CityUSA
  3. 3.Department of RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
  4. 4.Department of RadiologyNational Center for Child Health and DevelopmentTokyoJapan
  5. 5.Departments of Surgery and OncologyBoston Children’s Hospital/Dana Farber Cancer InstituteBostonUSA
  6. 6.Department of OncologyBirmingham Women’s and Children’s HospitalBirminghamUK
  7. 7.Department of Pediatric SurgeryHiroshima University HospitalHiroshimaJapan
  8. 8.Department of Surgery and Urology for Children and AdolescentsMedical University of GdanskGdanskPoland
  9. 9.Department of RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
  10. 10.Division of General and Thoracic SurgeryCincinnati Children’s HospitalCincinnatiUSA

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