BACKGROUND: Hepatoblastoma and hepatocellular carcinoma (HCC) are the most common primary malignant liver tumors in children. Although some characteristic imaging findings have been described in both hepatoblastoma and HCC, it is difficult to distinguish between these two tumors over the 5 years of age. OBJECTIVE: To investigate clinical and radiological findings that may help differentiate hepatoblastoma and HCC over 5 years of age. MATERIALS AND METHODS: From 2007 to 2022, 19 consecutive patients older than 5 years old diagnosed with primary liver malignancy were yielded from our radiology archive retrospectively. Imaging features, age, sex, treatment, and follow-up data were recorded. RESULTS: A total of 19 patients (16 boys
median age 7.5, min-max 5-17), ten HCCs and nine hepatoblastomas, were included. Serum alpha-fetoprotein (sAFP) values were significantly higher in hepatoblastoma patients (n=9), compared to the HCC (n=10) (P=0.002). Tumor size and PRETEXT stages were higher in hepatoblastoma patients
however, there was no statistical difference (P=0.06). Initial MRI was available for six patients with hepatoblastoma and seven patients with HCC, and there was no difference regarding ADCmin values. CONCLUSION: In the differential diagnosis of primary malignant liver tumor in a child older than 5 years of age, higher sAFP level may support the diagnosis of hepatoblastoma rather than HCC.