Imaging of abdominal neuroblastoma in children.

PURPOSE: The aims of the study were: 1) to assess the efficacy of different imaging methods for use prior to treatment; 2) to compare the surgico-histopathologically-based International Neuroblastoma Staging System (INSS) staging with the imaging results; and 3) to suggest a localisation scheme for abdominal neuroblastoma. MATERIAL AND METHODS: Thirty-one children with an abdominal neuroblastoma (median age 2 years), underwent abdominal US, CT of chest and abdomen, MR imaging of abdomen and spine, chest radiography, skeletal survey, radionuclide bone scintigraphy, MIBG scintigraphy, and bone marrow biopsy. RESULTS: In the evaluation of local disease, CT and MR were superior to US. There was no significant difference between CT and MR in assessment of the location or size of the tumour. Evaluation of invasive growth and lymphadenopathy was uncertain irrespective of imaging modality. Intraspinal extension was more distinctly demonstrated with MR. Tissue characterization with CT and MR did not contribute in the assessment of the tumours. Contrast enhancement at CT and MR examinations both improved demarcation between tumour and kidney, and was a necessity for evaluation of vessel encasement with CT. The local disease was best assessed by either CT or MR, while metastatic disease was best revealed by CT, MR, scintigraphy or bone marrow biopsy. CONCLUSION: Imaging may be a valuable basis for clinical assessment and pretreatment staging of abdominal neuroblastoma.     

Primary cerebral neuroblastoma: CT and MR findings in 12 cases

A retrospective CT, MR, and clinical study was performed in 12 patients, five children and seven adults, with histologically proved primary CNS neuroblastoma. The CT and MR appearances of this neoplasia were more variable than generally recognized. Although seven tumors were predominantly intraparenchymal masses with calcification and cyst formation, five were intra- or juxtaventricular. CT was preferable to noncontrast MR both at initial diagnosis and follow-up for identification of calcification, recurrent tumor at surgical sites, and leptomeningeal disease. Noncontrast MR was useful primarily for localization of peri- and intraventricular lesions. We conclude that primary CNS neuroblastoma has a more variable radiographic appearance than is generally recognized, and that an intra- or periventricular epicenter is common.     

Primary cerebral neuroblastoma: CT and MR findings in 12 cases

A retrospective CT, MR, and clinical study was performed in 12 patients, five children and seven adults, with histologically proved primary CNS neuroblastoma. The CT and MR appearances of these neoplasia were more variable than generally recognized. Although seven tumors were predominantly intraparenchymal masses with calcification and cyst formation, five were intra- or juxtaventricular. CT was preferable to noncontrast MR both at initial diagnosis and follow-up for identification of calcification, recurrent tumor at surgical sites, and leptomeningeal disease. Noncontrast MR was useful primarily for localization of peri- and intraventricular lesions. We conclude that primary CNS neuroblastoma has a more variable radiographic appearance than is generally recognized, and that an intra- or periventricular epicenter is common.     

MR imaging of intraspinal extension of neuroblastoma

The CT and magnetic resonance (MR) findings in two children with intraspinal extension of mediastinal neuroblastoma are described. The potential of MR to obviate the need for myelography is discussed.     

Pulmonary metastases at diagnosis of neuroblastoma in pediatric patients: CT findings and prognosis

OBJECTIVE: We undertook this study to determine the frequency, CT appearance, and clinical implications of the rare occurrence of pulmonary metastases among children presenting with neuroblastoma. MATERIALS AND METHODS: A search of the Children's Cancer Group database revealed 21 of 567 children with reported lung metastases at original diagnosis of neuroblastoma. CT examinations available for 17 of these patients were analyzed retrospectively to determine if lung metastases were present, and if so, to characterize their radiographic features. RESULTS: Seventeen (3%) of 567 patients presenting with Evans stage IV neuroblastoma had confirmed pulmonary metastases at diagnosis. All had metastases to at least one site other than the lungs. The most common CT appearance of pulmonary lesions was of up to five, small, bilateral, noncalcified nodules. In nine patients (53%), the pulmonary nodules initially resolved with treatment. In this cohort, six children developed progressive disease and died, and three are still alive. All eight children whose lung lesion did not completely respond to treatment died. Overall, children with pulmonary metastases had unfavorable Shimada histology, a higher association with amplification of the MYCN oncogene (p = 0.0002), and a decreased event-free survival (p < 0.001) when compared with all children with stage IV neuroblastoma without pulmonary metastases. CONCLUSION: The search for neuroblastoma lung metastases, which occur more frequently than previously reported, is clinically important because their presence portends a poor prognosis.     

Staging of neuroblastoma at imaging: report of the radiology diagnostic oncology group

PURPOSE: To compare the accuracies of computed tomography (CT), magnetic resonance (MR) imaging, and bone scintigraphy in staging disease in patients with neuroblastoma. MATERIALS AND METHODS: Ninety-six children with newly diagnosed neuroblastoma were enrolled in a multicenter prospective cohort study. CT, MR, and bone scintigraphy were used to evaluate tumor stage. Sensitivity and specificity values and receiver operating characteristic (ROC) curve analyses were used to compare the accuracy of CT, MR, and scintigraphy for tumor staging. RESULTS: Eighty-eight patients were eligible for staging analysis, and 45 patients who underwent surgery at initial diagnosis were eligible for analysis of local tumor extent. CT and MR had sensitivities of 43% and 83%, respectively (P <.01), and specificities of 97% and 88%, respectively (P >.05), for detection of stage 4 disease. Areas under the ROC curves for CT and MR were 0.81 and 0.85, respectively (P =.06); that for scintigraphy was 0.83. Addition of scintigraphy to both CT and MR increased the areas under the ROC curves to 0.90 and 0.88, respectively. Accuracy of CT and MR for staging disease confined to the chest or abdomen (stages 1, 2, and 3) was poor. CONCLUSION: MR alone and CT and MR combined with bone scintigraphy enable the accurate detection of stage 4 disease. Both CT and MR perform poorly for local tumor staging.     

Whole-body MRI of neuroblastoma

Whole-body MRI (WBMRI) is an emerging imaging method that has a great potential in pediatric oncologic imaging. It appears useful in staging and monitoring neuroblastoma although its clinical impact has not been thoroughly evaluated. Among various imaging techniques currently available for WBMRI, coronal and sagittal STIR imaging with a quadrature body coil at 1.5T MR system is recommended for a standard protocol. Nevertheless, further technical improvements are anticipated at 3.0T MR system and multi-channel surface coil system. Scan time of WBMRI is reasonably short ranging from 20 min to 60 min. In localized neuroblatoma, WBMRI may help in predicting surgical risks by evaluating image-defined risk factors accurately. In addition, WBMRI is quite useful in detecting distant metastasis, assessing initial treatment responses, and identifying tumor recurrence of neuroblastoma. We should understand limitations of WBMRI in the evaluation of lymph node involvement, in the differentiation between viable tumor and non-viable residual lesion, and in the detection of calcified lesion. Diffusion-weighted imaging may improve diagnostic accuracy of WBMRI. Complementary use of WBMRI and other metabolic imaging method such as MIBG scintigraphy or PET probably increases diagnostic accuracy and, subsequently, improves clinical outcome of children with neuroblastoma.     

小儿腹膜后成神经细胞瘤影像学与病理的对照研究

目的 探讨ＣＴ、ＭＲＩ对小儿腹膜后成神经细胞瘤的诊断价值和限度。方法 对３２例中２０例术前同时行ＭＲＩ、ＣＴ检查者与术中所见对照,并对其中１９例术后离体肿瘤的ＭＲＩ、ＣＴ影像与病理大切片对照。结果 ＭＲＩ表现一般为Ｔ１Ｗ１中低信号,Ｔ２Ｗ１明显高信号,且可见低信号网格及肿瘤对血管的包绕。组织学基础：原始成神经细胞核大密集,无间质;瘤巢周围有神经纤维。ＣＴ表现肿瘤为不均匀低密度,可见钙化。术前判断肿     

Scanning with iodine-131 MIBG in children with solid tumors: an initial appraisal

Twelve children with malignant disease in whom there was either a clinical, radiologic, or histologic differential diagnosis including neuroblastoma were investigated using iodine-131 metaiodobenzylguanidine (MIBG) scanning. In six children in whom a final diagnosis of neuroblastoma was substantiated, scans were positive; in five children with other malignancies, scans were negative. In one child, clinically and radiologically tumor free following excision on an abdominal neuroblastoma, scans were also negative. MIBG scanning proved of value as a discriminant of malignant undifferentiated tumors in children, and in the diagnosis and staging of neuroblastoma. During treatment, MIBG scans in two patients correlated with contemporaneous computed tomographic scans and may allow noninvasive monitoring of therapeutic response and completeness of surgical excision. Primary and recurrent abdominal tumors, and visceral, osseous, and marrow deposits were demonstrated using this technique.     

松果体区肿瘤的MRI诊断

目的分析松果体区肿瘤的MRI特征,以提高诊断准确率。资料与方法经手术病理证实的松果体区肿瘤23例,均行MR平扫及增强扫描。结果（1）不同的松果体区肿瘤,如：脑膜瘤、松果体实质肿瘤、生殖细胞肿瘤等各具有特征性的MRI表现;（2）某些肿瘤具有年龄和性别特征,如：神经母细胞瘤和松果体母细胞瘤患者发病年龄均〈10岁,生殖细胞瘤多发于青少年男性等。结论松果体区肿瘤具有较特征性的MRI表现,结合患者临床和发病年龄、性别、部位等特点,可进一步提高其术前诊断准确率。     

Current role of CT in pediatric ophthalmology

In spite of the recent and substantial improvements in MR technique, some problems still exist relative to its applications in routine clinical exams in pediatric ophthalmology. The main problems are: inadequate MR equipment, long examination time, and MR inability to demonstrate intraocular calcifications. Ocular and orbital ultrasound (US) studies are highly operator-dependent, and US utility has been especially described in evaluating ocular, but not orbital, lesions. In order to verify the actual role of CT in pediatric ophthalmology, the CT scans of 58 children with ophthalmologic pathologies, performed over a 2-year period, were reviewed and compared with definitive diagnoses. Seven separate CT findings for each pathologic condition were independently analyzed and correlated with histology. In agreement with other CT series, optic nerve gliomas were invariably intraconal, whereas histiocytosis-X, Ewing's sarcoma, olfactory neuroblastoma (esthesioneuroblastoma), metastatic neuroblastoma and nephroblastoma were extra-conal. Rhabdomyosarcoma, principally extraconal, frequently involved the intraconal and preseptal spaces, with permeative destruction of the osseous orbit and frequent intra/extracranial spread. Orbital spread was mainly observed in vascular tumors. CT showed great accuracy in evaluating punctuate calcifications in retinoblastomas and in metastatic neuroblastomas, and bone fragments within a zone of destruction in histiocytosis-X. Various characteristics of CT attenuation values were observed in pathologic tissues, and high attenuation and marked contrast enhancement were particularly observed in metastatic neuroblastomas and rhabdomyosarcomas. In congenital orbital abnormalities and inflammatory diseases, CT readily detected ocular malformations (microphthalmos and colobomata).(ABSTRACT TRUNCATED AT 250 WORDS)     

Current strategy for the imaging of neuroblastoma

Advances in the management of neuroblastoma lead radiologists and nuclear medicine specialists to optimize their procedures in order to propose a rational use of their techniques, adjusted to the various clinical presentations and to therapeutic management. The aim of this paper is to assess the imaging procedures for the diagnosis and follow-up of neuroblastoma in children according to current therapeutic European protocols. An imaging strategy at diagnosis is first proposed: optimal assessment of local extension of the primary tumour is made with MRI, or spiral-CT when MRI is not available, for all locations except for abdominal tumours for which CT remains the best imaging modality. Metastatic extension is assessed with mIBG scan and liver sonography. Indications for bone metastasis evaluation with either radiological or radionuclide techniques are detailed. Imaging follow-up during treatment for metastatic or unresectable tumours is described. A check-list of radiological main points to be evaluated before surgery is proposed for localized neuroblastoma. The imaging strategy for the diagnosis of "occult" neuroblastoma is considered. Finally, we explain the management of neuroblastoma detected during the prenatal or neonatal period.     

儿童神经母细胞瘤颅面骨转移的影像表现

目的 探讨儿童神经母细胞瘤颅面骨转移的影像表现.方法 回顾性分析12例经组织学证实的儿童神经母细胞瘤的影像表现.其中 10例患儿行CT平扫,6例行MRI,7例行全身SPECT骨扫描.结果 行CT检查的10例患儿中,9例表现为颅面骨溶骨性骨质破坏伴软组织肿块,其中8例可见骨膜反应,3例表现为特征性的针状骨膜反应;另l例cT未发现异常但骨扫描显示异常.行MR检查的6例患儿均表现为颅面骨骨髓腔信号异常伴周围软组织肿块,其中5例行增强扫描,骨髓腔异常信号影和软组织肿块呈明显不均匀强化.7例行全身骨扫描,均可见颅面部放射性浓聚区,其巾6例伴有全身其他部位的骨转移.结论神经母细胞瘤颅面骨转移有一定的影像特征,可提示诊断.     

Iodine-125-MIBG to treat neuroblastoma: preliminary report

Three children with Stage III neuroblastoma were treated with [125I]MIBG in a phase I toxicity study. Concepts of the treatment were: in small tumors, the absorbed dose of radiation from MIBG labeled with 131I is reduced but the absorbed dose from [125I]MIBG is less affected; and many recurrences of neuroblastoma arise from small tumors. Two patients exhibited only modest thrombocytopenia and leukopenia, the most sensitive indices of radiation toxicity, after receiving 261 and 407 mCi, and 83 and 104 rad of whole-body radiation. One patient died of progressive neuroblastoma; the other two patients have stable disease over 30 mo after treatment. Per millicurie given, [125I]MIBG imparts about one-fourth the radiation dose of [131I]MIBG to the whole body. Iodine-125-MIBG can be given in doses that impart over 100 rad of whole-body radiation and that exceed 400 mCi before toxicity becomes limiting, even in small children.     

White matter and cerebral metabolite changes in children undergoing treatment for acute lymphoblastic leukemia: longitudinal study with MR imaging and 1H MR spectroscopy

PURPOSE: To assess the development of white matter and cerebral metabolite changes during and after treatment in children with acute lymphoblastic leukemia. MATERIALS AND METHODS: Twenty-three children (10 boys, mean age of 6.3 years; 13 girls, mean age of 6.6 years) with acute lymphoblastic leukemia were examined prospectively with magnetic resonance (MR) imaging and MR spectroscopy at 0, 8, and 20 weeks and 1, 2, and 3 years after diagnosis. White matter changes were diagnosed on the basis of hyperintense abnormalities on T2-weighted MR images. Single-voxel hydrogen 1 MR spectroscopy results from the right frontoparietal region of 21 children who received intravenous high-dose methotrexate were analyzed for cerebral metabolite changes. Multilevel models were used to assess the change in metabolites from baseline levels at subsequent follow-up. RESULTS: At 20 weeks, MR spectroscopy showed a significant reduction (P <.05) of mean N-acetylaspartate to choline ratio and increase in mean choline to creatine ratio (P <.05) in the children given high-dose methotrexate. This decline in N-acetylaspartate to choline ratio subsequently reversed and increased, possibly because of normal age-related brain maturation. Seventeen of 21 (81%) children showed metabolite changes at MR spectroscopy, while five of 22 (23%) showed white matter changes at MR imaging at 20 weeks. One more child developed white matter changes at 32 weeks. The associated changes resolved or reduced with time. CONCLUSION: MR spectroscopy demonstrated metabolite changes in the brain after high-dose methotrexate treatment in the absence of structural white matter abnormalities at MR imaging. MR spectroscopy might thus be a more sensitive method of monitoring the effects of high-dose methotrexate in the brain.     

MR imaging of diffuse bone marrow replacement in pediatric patients with cancer

In the magnetic resonance (MR) imaging examinations of three children with tumors (two neuroblastoma, one rhabdomyosarcoma) and three with leukemia, the marrow demonstrated a diffuse, uniform pattern of hypointensity on T1-weighted images and hyperintensity on T2-weighted images. The authors observed that this reversal ("flip-flop") of the usual MR characteristics of fatty marrow was seen in the epiphyses, metaphyses, and diaphyses. The purpose of this study was to establish the radiographic and clinicopathologic correlates of this MR finding on the basis of findings from plain radiographs, bone scans, and bone marrow aspirates. Plain radiographs and bone scans demonstrated either normal findings or changes limited to the metaphyses. In all patients, analysis of bone marrow aspirates demonstrated metastases. The authors concluded that even in the absence of evidence of discrete bone metastases on a plain radiograph or a bone scan, this diffuse and uniform "flip-flop" pattern reflects diffuse marrow replacement by tumor cells.     

Cervicothoracic lesions in infants and children.

Cervicothoracic lesions are not uncommon in children. All cervicothoracic lesions except superficial lesions extend from the neck to the thorax through the thoracic inlet. Evaluation of this area involves multiple imaging modalities: plain radiography, ultrasonography, nuclear medicine, computed tomography, and magnetic resonance (MR) imaging. However, MR imaging is the method of choice for assessing the full extents of cervicothoracic lesions and their relationships to neurovascular structures. Cervicothoracic lesions can be classified as congenital lesions, inflammatory lesions, benign tumors, malignant tumors, and traumatic lesions. Lymphangioma is the most common cervicothoracic mass in children; other congenital lesions include hemangioma, thymic cyst, and vascular anomalies. Inflammatory adenopathy reactive to tuberculosis, mononucleosis, tularemia, cat-scratch fever, infection with human immunodeficiency virus, or other upper respiratory tract infections can manifest as cervicothoracic lesions; tuberculous abscesses and abscesses of other origins can also be seen. Lipoma, lipoblastoma, aggressive fibromatosis, and nerve sheath tumors (either isolated lesions or those associated with neurofibromatosis) can also occur as cervicothoracic masses. Malignant cervicothoracic tumors include lymphoma, thyroid carcinoma, neuroblastoma, and chest wall tumors (rhabdomyosarcoma, Ewing sarcoma, and neuroectodermal tumor). Traumatic cervicothoracic lesions include pneumomediastinum of traumatic origin, traumatic pharyngeal pseudodiverticulum, esophageal foreign-body granuloma, and cervicothoracic hematoma.     

Brain MR imaging in children with developmental retardation of unknown cause: results in 76 cases.

Seventy-six children with developmental retardation of unknown cause underwent MR imaging of the brain. Twenty-one (28%) had positive MR findings, including nine with atrophy, six with delayed myelination, four with multiple focal white matter lesions, three with hypoplastic white matter, and three with migration abnormalities. The frequency of abnormality was highest in nonautistic children with associated neurologic physical findings (61%) but was also significant in nonautistic children without neurologic findings (23%). We did not detect abnormalities on MR images of autistic retarded children. Delayed myelination and migration abnormalities were the predominant abnormalities in children with associated neurologic findings, whereas focal white matter lesions were more common in children without neurologic findings. Abnormalities were significantly more common in children with a small head circumference. Although MR did not have any effect on treatment or prognosis, it did aid the clinician in family counseling. MR will reveal brain abnormalities in about one third of nonautistic children with developmental retardation of unknown cause, and more often in those with neurologic deficits, seizures, or a small head size.     

Magnetic resonance imaging of knee injuries in children

The appearances of knee injuries on MR imaging are less well documented in children than adults. Some patterns of injury are shared by both groups of patients, e. g. meniscal damage. The frequency of specific injuries may differ, e. g. anterior cruciate ligament (ACL) tear. Congenital abnormality, coexistent pathology and previous treatment of the knee appear to be associated with meniscal problems. Discoid menisci are seen most frequently in children and have unique features on MR scans. Cruciate ligament tears are difficult to diagnose in the smallest children. The ACL may not be identified due to its small size. Normal bone marrow signal may be confused with marrow infiltration or bone microfracture. Radiographically occult fractures around the knee appear to be strongly associated with ligamentous injury as in adult patients. Osteochondral fractures, osteochondral lesions and articular cartilage damage are revealed on MR scans, but their long-term effects are uncertain. It is possible to diagnose a range of knee injuries on MR scans in children. The biggest diagnostic challenge is in pre-school children. Received 13 December 1996; Revision received 13 March 1997; Accepted 14 March 1997     

第三脑室肿瘤的CT和MRI诊断

本文回顾了１５例病理证实的第三脑室肿瘤的ＣＴ和ＭＲＩ表现，包括６例星形胶质细胞瘤，３例胶样囊肿，２例颅咽管瘤，２例畸胎瘤，１例室管膜瘤，１例神经母细胞瘤，讨论了它们的影像学特征及其鉴别诊断。ＣＴ显示钙化敏感，对肿瘤诊断帮助很大，ＭＲＩ具有多维成像能力，可准确确定肿瘤的位置及范围。