[Magnetic resonance imaging of benign and premalignant tumors in childhood]

3D surgical planning of pediatric tumors: a review

BACKGROUND

3D surgical planning for the treatment of tumors in pediatrics using different neuroimaging methods is witnessing an accelerating and dynamic development. Until now, there have been many reports on the use of 3D printing techniques in different aspects of medical practice. Pediatric tumors mainly in the abdomen are among the most medical specialties that benefit from using this technique. The purpose of the current study is to review published literature regarding 3D surgical planning and its applications in the treatment of pediatric tumors and present challenges facing these techniques.

MATERIALS AND METHODS

A completed review of the available literature was performed, effect sizes from published studies were investigated, and results are presented concerning the use of 3D surgical planning in the management of pediatric tumors, most of which are abdominal.

RESULTS

According to the reviewed literature, our study comes to the point that 3D printing is a valuable technique for planning surgery for pediatric tumors in heart, brain, abdomen and bone. MRI and CT are the most common used techniques for preparing 3D printing models, as indicated by the reviewed reports. The reported studies have indicated that 3D printing allows the understanding of the anatomy of complex tumor cases, the simulation using surgical instruments, and medical and family education. The materials, 3D printing techniques and costs to be used depend on the application.

CONCLUSION

This technology can be applied in clinical practice with a wide spectrum, using various tools and a range of available 3D printing methods. Incorporating 3D printing into an effective application can be a gratifying process with the use of a multidisciplinary team and rapid advances, so more experience would be needed with this technique to show a clinical gain.

Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma

OBJECTIVE

The objectives of this study were to compare MRI and iodine-123 ((123)I) metaiodobenzylguanidine (MIBG) scintigraphy in the detection of neuroblastoma lesions in pediatric patients and to assess the additional value of combined imaging.

MATERIALS AND METHODS

Fifty MRI and 50 (123)I MIBG examinations (mean interval, 6.4 days) were analyzed retrospectively with regard to suspected or proven neuroblastoma lesions (n = 193) in 28 patients. MRI and MIBG scans were reviewed by two independent observers each. Separate and combined analyses of MRI and MIBG scintigraphy were compared with clinical and histologic findings.

RESULTS

With regard to the diagnosis of neuroblastoma lesion, MIBG scintigraphy, MRI, and combined analysis showed a sensitivity of 69%, 86%, and 99% and a specificity of 85%, 77%, and 95%, respectively. On MRI, 15 false-positive findings were recorded: posttherapeutic reactive changes (n = 10), benign adrenal tumors (n = 3), and enlarged lymph nodes (n = 2). On MIBG scintigraphy, 10 false-positive findings occurred: ganglioneuromas (n = 2), benign liver tumors (n = 2), and physiologic uptake (n = 6). Thirteen neuroblastoma metastases and two residual masses under treatment with chemotherapy were judged to be false-negative findings on MRI. Two primary or residual neuroblastomas and one orbital metastasis were misinterpreted as Wilms' tumor, reactive changes after surgery, and rhabdomyosarcoma on MRI. Thirty-two bone metastases, six other neuroblastoma metastases, and one adrenal neuroblastoma showed no MIBG uptake. On combined imaging, one false-negative (bone metastasis) and three false-positive (two ganglioneuromas and one pheochromocytoma) findings remained.

CONCLUSION

In the assessment of neuroblastoma lesions in pediatric patients, MRI showed a higher sensitivity and MIBG scintigraphy a higher specificity. However, integrated imaging showed an increase in both sensitivity and specificity.