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Proposed strategies to address PRETEXT challenges include broader implementation of standardized imaging protocols and structured reporting, multidisciplinary integration, central review, definition refinement, and emerging technologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Addressing these challenges may improve diagnostic accuracy, risk stratification, and clinical decision-making in pediatric patients with malignant liver tumors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00247-026-06786-w","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T08:44:07Z","timestamp":1791189847000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges with the PRETEXT staging system: a SIOPEL Radiology Group position paper"],"prefix":"10.1007","author":[{"given":"Siri Margrete Hugo","family":"Lohne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-8241","authenticated-orcid":false,"given":"Hanna","family":"Hebelka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jip Frederik","family":"Prince","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneloes Elisabeth","family":"Bohte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemieke Simone","family":"Littooij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5990-1781","authenticated-orcid":false,"given":"Charlotte","family":"de Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4868-9604","authenticated-orcid":false,"given":"Annamaria","family":"Deganello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0862-6967","authenticated-orcid":false,"given":"Silvia","family":"Costa Dias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2000-3201","authenticated-orcid":false,"given":"Greg","family":"Chambers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Toso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Habre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Pace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3200-751X","authenticated-orcid":false,"given":"St\u00e9phanie","family":"Franchi-Abella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Woodley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8095-5512","authenticated-orcid":false,"given":"Simon P.","family":"McGuirk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"6786_CR1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/S1470-2045(16)30598-8","volume":"18","author":"RL Meyers","year":"2017","unstructured":"Meyers RL, Maibach R, Hiyama E et al (2017) Risk-stratified staging in paediatric hepatoblastoma: a unified analysis from the Children\u2019s Hepatic tumors International Collaboration. 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