Magnetic resonance imaging of neuroblastoma with a 0.15-T magnet

Sphenoid masses in children: radiologic differential diagnosis with pathologic correlation

Childhood central skull base masses are rare, often difficult to diagnose, and have overlapping imaging findings. In this review, we provide an overview of the epidemiology, clinical findings, and management of pediatric sphenoid bone and sphenoid sinus masses with an emphasis on imaging findings that may help to differentiate lesions. Radiologic-pathologic correlation is provided. Finally, an imaging-based algorithm is presented as a guide to help radiologists narrow their differential diagnoses. Some of the entities discussed are virtually unique to the pediatric population; others occur rarely in this age group but should be considered in the appropriate clinical setting. Entities included in the discussion are grouped into 2 categories: those that cause nonaggressive osseous remodeling and those that are more commonly associated with aggressive bone changes. Mucocele, aneurysmal bone cyst, giant cell lesions, meningioma, and fibrous dysplasia tend to remodel bone, while entities such as chordoma, craniopharyngioma, rhabdomyosarcoma, sinonasal carcinoma, and neuroblastoma may cause more aggressive local bone changes.

Adrenal neuroblastoma in an adult with tumor thrombus in the inferior vena cava

We describe the appearance of an adrenal neuroblastoma associated with tumor thrombus occurring in an adult patient. The tumor measured 14 x 12 x 12 cm, showed heterogeneous signal intensity on both T1-weighted and T2-weighted images, and displayed peripheral nodular enhancement on early post-gadolinium images. Tumor thrombus was identified within the inferior vena cava, which extended into the right atrium.

Magnetic resonance imaging of neuroblastoma using current techniques

We evaluated the ability of current magnetic resonance (MR) scanning techniques to detect and stage neuroblastoma in children, using surgical and histopathologic correlation. We prospectively and retrospectively reviewed 16 MR examinations from 14 patients with neuroblastoma (13 patients) or ganglioneuroblastoma (1 patient) and compared these to computed tomography (CT) (5 patients) and pathology (all patients). Sequences included: precontrast T1-weighted and T2-weighted images, and gadolinium-enhanced T1-weighted images. The study time for each MR exam was also calculated. Five primary tumors were intrathoracic paraspinous masses, eight were adrenal, and 1 was presacral. Neural foraminal invasion was demonstrated on MR in four of 14 patients. Three of the four patients had undergone CT and neural foraminal invasion was shown in one. Vascular encasement was demonstrated in five of 14 patients on MR images. Three of the five patients had undergone CT and vascular involvement was shown in two. All cases of neural foramina invasion and vascular encasement were proven at surgery. There were no false positive or false negative MR studies of neural foraminal invasion or vascular encasement. Bone marrow invasion was shown in two of 14 patients on MR images which were confirmed by bone marrow aspirate. No false negative cases of bone marrow invasion was shown. In one patient, CT considered one neuroblastoma to be adrenal in location which was correctly shown to be intrathoracic on MR. The mean study time for MR imaging was 49 min. Current MR techniques are accurate at detecting and staging neuroblastoma, and coverage of chest, abdomen, and pelvis can be performed in less than one hour.

Imaging of neuroblastoma in patients identified by mass screening using urinary catecholamine metabolites

Between April 1983 and August 1991, mass screening in Chiba Prefecture found 25 infants to be positive for neuroblastoma based on elevated urinary levels of catecholamine metabolites. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy (BS), and 67Ga scintigraphy (GS) detected neuroblastomas in 12 of the 25 infants. The primary site of tumor was the mediastinum in 1 patient, the adrenal gland in 7, retroperitoneum in 3, and pelvis in 1. To determine the accuracy of each imaging technique, the percent sensitivity (SE), percent specificity (SP), and percent accuracy (AC) were determined for each technique from surgical findings and a follow-up study. MRI showed the highest diagnostic accuracy (100% for SE, SP, and AC), followed by CT (100%, 92%, 96%), US (82%, 92%, 88%), BS (58%, 100%, 80%), and GS (42%, 85%, 64%) in that order. MRI is most suitable for the imaging of individuals judged to be positive in the mass screening for neuroblastoma because of the advantages of visualization of the spread of tumor and the relationship of tumor to the great blood vessels, important determinants of resectability and therapy.

The pediatric patient with suspected adrenal neoplasm: which radiological test to use?

To establish which radiological test to use in a pediatric patient with suspected neoplasm, we retrospectively studied 19 children with proven adrenal neoplasm who had a combination of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The results show that US should remain the initial imaging modality for evaluating abdominal masses in children but that MRI is more accurate than CT and US in detecting the organ of origin and the extent of an adrenal lesion and should, therefore, be the modality of choice for the definitive evaluation of adrenal neoplasm in children.

Neuroblastoma: evaluation with contrast enhanced MR imaging

The use of GD-DTPA was introduced recently for MR imaging of the body. This paper presents our experience with GD-DTPA enhanced MRI in the evaluation of neuroblastoma in children. The characteristics of the tumor-enhancement are described, its contribution to the diagnosis and the follow-up of this disease are discussed.

MRI of the adrenal gland

Current status of magnetic resonance imaging (MRI) of the adrenal gland is reviewed, and basic techniques and sensitivity of MRI for differentiating histologic lesions are also discussed.

Neuroblastoma in an adult causing spinal cord compression: report of a case and review of the literature

Adult neuroblastoma (ANB) is an uncommon malignancy, there being only 42 reported cases in the world literature. The purpose of this report is to present a case of ANB with spinal cord compression by an intraspinal component, and review methods of diagnosis and treatment. NB is one of the most frequent childhood malignancies (90% of the patients are less than 10 years old) and both pathologists and clinicians tend to exclude it from differential diagnosis when the patient is an adult. When the tumour is located in the paraspinal region, local extension through the intervertebral foramen into the spinal canal can occur in a dumbbell fashion, a pattern of growth first described by Weber in 1856.

4-S neuroblastoma on high field MR

The appearance of 4-S neuroblastoma imaged with high field strength MR are reported. The correlative pathological findings are described.

[Results of scintigraphy with m-[123I]iodobenzylguanidine in neuroblastoma in children]

From 46 [123I]m IBG scans performed in 33 children, excellent specificity (96%) and good sensitivity (90%) appeared in the detection of neuroblastoma; less differentiated non catecholamine-excreting tumours remained undetected. As any localization to be seen was clearly visualized on the 24-h scan, the use of the [123I]m IBG (p, 5n) is recommended for the diagnosis, staging and follow-up of neuroblastoma in children.

Magnetic resonance imaging of the adrenal glands

Applications of nuclear magnetic resonance (NMR) to the adrenal gland have received considerable attention in recent years. Using high field strength magnets and surface coil technology, images of normal and abnormal adrenal glands have been obtained that compare favorably, and in some instances excel, computed tomography (CT) with respect to both image quality and, to a greater degree, differentiation of pathology. This article reviews the current state of magnetic resonance (MR) imaging of normal and abnormal adrenal glands, compares MR with CT imaging, and indicates where NMR spectroscopy has been of greatest value to date in the study of adrenal gland disease.

Magnetic resonance imaging of Wilms tumor

Magnetic resonance imaging (MRI) in 4 children with Wilms tumor suggests the usefulness of this newer imaging modality in evaluating the organ of origin and defining the extent of Wilms tumor. Coronal T1-weighted images were the most useful pulsing sequence for evaluating these children.