1
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Pereira HR, Barzegar M, Hamadelseed O, Esteve AV, Munuera J. 3D surgical planning of pediatric tumors: a review. Int J Comput Assist Radiol Surg 2022; 17:805-816. [PMID: 35043366 DOI: 10.1007/s11548-022-02557-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Helena Rico Pereira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da, Universidade de Lisboa, Campo Grande, C1 Building, 3rd Floor, 1749-016, Lisboa, Portugal. .,Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-517, Caparica, Portugal.
| | - Mojtaba Barzegar
- Intelligent Quantitative Biomedical Imaging (Iqbmi), 1955748171, Tehran, Iran.,School of Medical Physics and Medical Engineering, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, 71348-14336, Shiraz, Iran.,Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, 90272, USA
| | - Osama Hamadelseed
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, University of Heidelberg, Im Neuenheimer Feld 307, 69120, Heidelberg, Germany
| | - Arnau Valls Esteve
- 3D4H Unit, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,Innovation Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Spain
| | - Josep Munuera
- Imatge Diagnòstica i Terapéutica, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,Servei de Diagnòstic per la Imatge, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Spain.,3D4H unit, Institut de Recerca Sant Joan de Déu, PasseigSant Joan deDéu 2, 08950, Esplugues deLlobregat, Spain
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2
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Behr GG, Zheng J, Capanu M, Price AP. Is IV contrast necessary for MRI follow-up in children with abdominal neuroblastoma? Clin Imaging 2021; 79:259-264. [PMID: 34157502 PMCID: PMC10017112 DOI: 10.1016/j.clinimag.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The safety of multiple doses of gadolinium-based MRI IV contrast has recently been called in to question. While the long-term safety is being investigated, here, we seek to determine if there is added value to the use of IV contrast for improving detection of tumoral recurrences in children with a history of abdominal neuroblastoma. METHODS This is a retrospective review of children who underwent abdominal MRI with gadolinium contrast. One radiologist reviewer determined presence or absence of tumor, both before and after administration of IV contrast material and documented level of confidence when a finding was encountered. Change in reader confidence after the use of contrast was measured and fraction of missed lesions on pre-contrast was calculated. Liver and spleen lesions were documented separately. RESULTS 453 MRI scans in 110 unique patients were reviewed. 65 patients were documented to have a total of 125 lesions, excluding liver, spleen and bones. There were 23 instances of contrast altering the radiologist's confidence and one lesion was missed without the use of contrast. Among liver and spleen, several hepatic lesions were seen only after contrast, but all were benign lesions. CONCLUSION In selected patients who are undergoing MRI for neuroblastoma, it may be reasonable to forgo the use of IV contrast.
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Affiliation(s)
- Gerald G Behr
- Dept. Radiology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Junting Zheng
- Dept. of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, United States of America
| | - Marinela Capanu
- Dept. of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, United States of America
| | - Anita P Price
- Dept. Radiology, Memorial Sloan Kettering Cancer Center, United States of America
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3
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Skoczen S, Stepien K, Krzysztofik M, Luszawska T, Hnatko-Kolacz M, Korostynski M, Piechota M, Kolanek K, Wyrobek L, Wysocka K, Gorecki W, Balwierz W. Genetic Profile and Clinical Implications of Hepatoblastoma and Neuroblastoma Coexistence in a Child. Front Oncol 2019; 9:230. [PMID: 31019896 PMCID: PMC6458242 DOI: 10.3389/fonc.2019.00230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
The aim of the following case report is to provide a description of the coexistence of two independent tumors in a child. A 9-month-old male was referred to Department of Pediatric Oncology and Hematology with hepatic tumor present on ultrasound imaging and symptoms of enlarged abdominal circumference. Physical examination revealed a palpable epigastric mass and the imaging techniques showed a tumor of the left hepatic lobe measuring 11 × 6.5 × 8.9 cm with pancreas infiltration, distant metastases in both lungs and abnormal lesion in the left adrenal gland. Basing on histopathological examination, after a core-needle biopsy, hepatoblastoma (HBL) (mixed epithelial-mesenchymal subtype) was diagnosed. The α-fetoprotein level was 112 993 ng/ml. Elevated values of normetanephrine, 3-methoxytyramine as well as neuron-specific enolase were observed. Due to the clinical picture and diagnosis, the patient was qualified to preoperative chemotherapy according to the SIOPEL-3 protocol, followed by SIOPEL-4 protocol for the high-risk patients. After undergoing preoperative chemotherapy, imaging tests revealed regression of hepatic tumor and no focal pulmonary masses, while regression of adrenal gland mass was not completed. The patient was qualified for left hemihepatectomy with left adrenalectomy. Histopathological examination of liver specimen confirmed the HBL diagnosis. However, in left adrenal gland and paraaortic lymph nodes the residual neuroblastoma (NBL) cells were detected. Whole exome sequencing (WES) was utilized to identify disease-associated germline mutations. WES revealed a novel germline insertion variant in TWIST1 (p.Gly86dup), along with the potentially pathogenic non-synonymous variants in NF1 (p.Val2511Ile), RAF1 (p.Leu445Arg), and WHSC1 (p.Ser4Asn) genes. Currently, 6 months after completion of treatment according to the SIOPEL-4 protocol, the patient is in good general condition, without any signs, and symptoms of relapse of both neoplasms. The coexistence of two different primary childhood malignancies is rarely seen. So far, only one case of synchronous HBL and NBL has been reported. However, for the first time therapeutic process was successful. A specific signature of rare germline mutations can be proposed as a predisposing factor to synchronous HBL and NBL occurrence.
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Affiliation(s)
- Szymon Skoczen
- Department of Oncology and Hematology, University Children's Hospital, Krakow, Poland.,Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Konrad Stepien
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Krzysztofik
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Luszawska
- Department of Oncology and Hematology, University Children's Hospital, Krakow, Poland
| | | | - Michal Korostynski
- Department of Molecular Neuropharmacology, Institute of Pharmacology of Polish Academy of Sciences, Krakow, Poland.,Intelliseq sp. z o.o., Krakow, Poland
| | - Marcin Piechota
- Department of Molecular Neuropharmacology, Institute of Pharmacology of Polish Academy of Sciences, Krakow, Poland.,Intelliseq sp. z o.o., Krakow, Poland
| | | | - Lukasz Wyrobek
- Department of Radiology, University Children's Hospital, Krakow, Poland
| | - Katarzyna Wysocka
- Department of Pathology, University Children's Hospital, Krakow, Poland
| | - Wojciech Gorecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Walentyna Balwierz
- Department of Oncology and Hematology, University Children's Hospital, Krakow, Poland.,Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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4
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Abstract
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system, and is metastatic or otherwise high risk for relapse in nearly 50% of cases, with a long-term survival of <40%. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for finding the adequate therapeutic choice. The tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor-specific agent for imaging. On the contrary, MIBG imaging has several disadvantages such as limited spatial resolution, limited sensitivity in small lesions, need for two or even more acquisition sessions, and a delay between the start of the examination and result. Most of these limitations can be overcome with positron emission tomography (PET) using different radiotracers. Furthermore, for operative or biopsy planning, a combination with morphological imaging methods is indispensable. This article would discuss the therapeutic strategy for primary and follow-up diagnosis in neuroblastoma using MIBG scintigraphy and different new PET tracers as well as multimodality imaging.
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Affiliation(s)
- Thomas Pfluger
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
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5
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Bleeker G, Tytgat GAM, Adam JA, Caron HN, Kremer LCM, Hooft L, van Dalen EC. 123I-MIBG scintigraphy and 18F-FDG-PET imaging for diagnosing neuroblastoma. Cochrane Database Syst Rev 2015; 2015:CD009263. [PMID: 26417712 PMCID: PMC4621955 DOI: 10.1002/14651858.cd009263.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Neuroblastoma is an embryonic tumour of childhood that originates in the neural crest. It is the second most common extracranial malignant solid tumour of childhood.Neuroblastoma cells have the unique capacity to accumulate Iodine-123-metaiodobenzylguanidine (¹²³I-MIBG), which can be used for imaging the tumour. Moreover, ¹²³I-MIBG scintigraphy is not only important for the diagnosis of neuroblastoma, but also for staging and localization of skeletal lesions. If these are present, MIBG follow-up scans are used to assess the patient's response to therapy. However, the sensitivity and specificity of ¹²³I-MIBG scintigraphy to detect neuroblastoma varies according to the literature.Prognosis, treatment and response to therapy of patients with neuroblastoma are currently based on extension scoring of ¹²³I-MIBG scans. Due to its clinical use and importance, it is necessary to determine the exact diagnostic accuracy of ¹²³I-MIBG scintigraphy. In case the tumour is not MIBG avid, fluorine-18-fluorodeoxy-glucose ((18)F-FDG) positron emission tomography (PET) is often used and the diagnostic accuracy of this test should also be assessed. OBJECTIVES PRIMARY OBJECTIVES 1.1 To determine the diagnostic accuracy of ¹²³I-MIBG (single photon emission computed tomography (SPECT), with or without computed tomography (CT)) scintigraphy for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old.1.2 To determine the diagnostic accuracy of negative ¹²³I-MIBG scintigraphy in combination with (18)F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old, i.e. an add-on test. SECONDARY OBJECTIVES 2.1 To determine the diagnostic accuracy of (18)F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old.2.2 To compare the diagnostic accuracy of ¹²³I-MIBG (SPECT-CT) and (18)F-FDG-PET(-CT) imaging for detecting a neuroblastoma and its metastases at first diagnosis or at recurrence in children from 0 to 18 years old. This was performed within and between included studies. ¹²³I-MIBG (SPECT-CT) scintigraphy was the comparator test in this case. SEARCH METHODS We searched the databases of MEDLINE/PubMed (1945 to 11 September 2012) and EMBASE/Ovid (1980 to 11 September 2012) for potentially relevant articles. Also we checked the reference lists of relevant articles and review articles, scanned conference proceedings and searched for unpublished studies by contacting researchers involved in this area. SELECTION CRITERIA We included studies of a cross-sectional design or cases series of proven neuroblastoma, either retrospective or prospective, if they compared the results of ¹²³I-MIBG (SPECT-CT) scintigraphy or (18)F-FDG-PET(-CT) imaging, or both, with the reference standards or with each other. Studies had to be primary diagnostic and report on children aged between 0 to 18 years old with a neuroblastoma of any stage at first diagnosis or at recurrence. DATA COLLECTION AND ANALYSIS One review author performed the initial screening of identified references. Two review authors independently performed the study selection, extracted data and assessed the methodological quality.We used data from two-by-two tables, describing at least the number of patients with a true positive test and the number of patients with a false negative test, to calculate the sensitivity, and if possible, the specificity for each included study.If possible, we generated forest plots showing estimates of sensitivity and specificity together with 95% confidence intervals. MAIN RESULTS Eleven studies met the inclusion criteria. Ten studies reported data on patient level: the scan was positive or negative. One study reported on all single lesions (lesion level). The sensitivity of ¹²³I-MIBG (SPECT-CT) scintigraphy (objective 1.1), determined in 608 of 621 eligible patients included in the 11 studies, varied from 67% to 100%. One study, that reported on a lesion level, provided data to calculate the specificity: 68% in 115 lesions in 22 patients. The sensitivity of ¹²³I-MIBG scintigraphy for detecting metastases separately from the primary tumour in patients with all neuroblastoma stages ranged from 79% to 100% in three studies and the specificity ranged from 33% to 89% for two of these studies.One study reported on the diagnostic accuracy of (18)F-FDG-PET(-CT) imaging (add-on test) in patients with negative ¹²³I-MIBG scintigraphy (objective 1.2). Two of the 24 eligible patients with proven neuroblastoma had a negative ¹²³I-MIBG scan and a positive (18)F-FDG-PET(-CT) scan.The sensitivity of (18)F-FDG-PET(-CT) imaging as a single diagnostic test (objective 2.1) and compared to ¹²³I-MIBG (SPECT-CT) (objective 2.2) was only reported in one study. The sensitivity of (18)F-FDG-PET(-CT) imaging was 100% versus 92% of ¹²³I-MIBG (SPECT-CT) scintigraphy. We could not calculate the specificity for both modalities. AUTHORS' CONCLUSIONS The reported sensitivities of ¹²³-I MIBG scintigraphy for the detection of neuroblastoma and its metastases ranged from 67 to 100% in patients with histologically proven neuroblastoma.Only one study in this review reported on false positive findings. It is important to keep in mind that false positive findings can occur. For example, physiological uptake should be ruled out, by using SPECT-CT scans, although more research is needed before definitive conclusions can be made.As described both in the literature and in this review, in about 10% of the patients with histologically proven neuroblastoma the tumour does not accumulate ¹²³I-MIBG (false negative results). For these patients, it is advisable to perform an additional test for staging and assess response to therapy. Additional tests might for example be (18)F-FDG-PET(-CT), but to be certain of its clinical value, more evidence is needed.The diagnostic accuracy of (18)F-FDG-PET(-CT) imaging in case of a negative ¹²³I-MIBG scintigraphy could not be calculated, because only very limited data were available. Also the detection of the diagnostic accuracy of index test (18)F-FDG-PET(-CT) imaging for detecting a neuroblastoma tumour and its metastases, and to compare this to comparator test ¹²³I-MIBG (SPECT-CT) scintigraphy, could not be calculated because of the limited available data at time of this search.At the start of this project, we did not expect to find only very limited data on specificity. We now consider it would have been more appropriate to use the term "the sensitivity to assess the presence of neuroblastoma" instead of "diagnostic accuracy" for the objectives.
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Affiliation(s)
- Gitta Bleeker
- Northwest ClinicsRadiology and Nuclear MedicinePO box 501AlkmaarNetherlands1800 AM
| | - Godelieve AM Tytgat
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
| | - Judit A Adam
- Amsterdam UMC, University of AmsterdamNuclear Medicine and RadiologyP.O. Box 22660AmsterdamNetherlands1100 DD
| | - Huib N Caron
- F. Hoffmann‐La Roche AGiPODD Pediatric Oncology team, Pharma Development OncologyBldg/Room 682/332BaselSwitzerland4070
| | - Leontien CM Kremer
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsRoom Str. 6.127P.O. Box 85500UtrechtNetherlands3508 GA
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
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6
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Mueller WP, Coppenrath E, Pfluger T. Nuclear medicine and multimodality imaging of pediatric neuroblastoma. Pediatr Radiol 2013; 43:418-27. [PMID: 23151727 DOI: 10.1007/s00247-012-2512-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/22/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging.
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Affiliation(s)
- Wolfgang Peter Mueller
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
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7
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Abstract
Neuroblastoma is the most common pediatric extracranial soft-tissue tumor, accounting for approximately 8% of childhood malignancies. Its prognosis is widely variable, ranging from spontaneous regression to fatal disease despite multimodality therapy. Multiple imaging and clinical tests are needed to accurately assess patient risk with risk groups based on disease stage, patient age, and biological tumor factors. Approximately 60% of patients with neuroblastoma have metastatic disease, most commonly involving bone marrow or cortical bone. Metaiodobenzylguanidine (mIBG) scintigraphy plays an important role in the assessment of neuroblastoma, allowing whole-body disease assessment. mIBG is used to define extent of disease at diagnosis, assess disease response during therapy, and detect residual and recurrent disease during follow-up. mIBG is highly sensitive and specific for neuroblastoma, concentrating in >90% of tumors. mIBG was initially labeled with (131)I, but (123)I-mIBG yields higher quality images at a lower patient radiation dose. (123)I-mIBG (AdreView; GE Healthcare, Arlington Heights, IL) was approved for clinical use in children by the Food and Drug Administration in 2008 and is now commercially available throughout the United States. The use of single-photon emission computed tomography and single-photon emission computed tomography/computed tomography in (123)I-mIBG imaging has improved certainty of lesion detection and localization. Fluorodeoxyglucose positron-emission tomography has recently been compared with mIBG and found to be most useful in neuroblastomas which fail to or weakly accumulate mIBG.
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Affiliation(s)
- Susan E Sharp
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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8
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Michael R. Potential of MR-imaging in the paediatric abdomen. Eur J Radiol 2008; 68:235-44. [PMID: 18848412 DOI: 10.1016/j.ejrad.2008.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 07/16/2008] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the potential and relevant applications of MR-imaging (MRI) in typical paediatric abdominal conditions and diseases. METHOD The commonly used indications, applications, and sequences as well as typical imaging findings of paediatric abdominal MRI are presented and discussed, with emphasis on specific paediatric needs and queries. Only applications as used in routine clinical work are listed, other more sophisticated and advanced techniques will only briefly be mentioned. Furthermore, some aspects of paediatric MR Urography are presented and discussed. CONCLUSION Though conventional imaging methods (ultrasound and plain film) are valuable and - particularly in the paediatric abdomen - form the mainstay of routine imaging in paediatric abdominal radiology, some conditions require sectional imaging. MRI is increasingly applied to these queries in neonates, infants and children as an alternative method to CT without any radiation burden, and - when performed adequately and skilfully - can answer most treatment relevant questions. MR will increasingly be applied with new applications and broader availability also with functional information deriving from new equipment and research offering an ideal one stop imaging approach to many conditions also in children.
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Affiliation(s)
- Riccabona Michael
- Department of Radiology, Division of Paediatric Radiology, LKH Graz, University Hospital, Auenbruggenplatz, A-8036 Graz, Austria.
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9
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10
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Abstract
The differential diagnosis of renal and supra-renal masses firstly depends on the age of the child. Neuroblastoma (NBL) may be seen antenatally or in the newborn period; this tumour has a good prognosis unlike NBL seen in older children (particularly NBL in those aged 2-4 years). Benign renal masses predominate in early infancy but beyond the first year of life Wilms' tumour is the most common renal malignancy, until adolescence when renal cell carcinoma has similar or increased frequency as children get older. Adrenal adenomas and carcinomas also occur in childhood; these tumours are indistinguishable on imaging but criteria for the diagnosis of adrenal carcinoma include size larger than 5 cm, a tendency to invade the inferior vena cava and to metastasise. The most topical dilemmas in the radiological assessment of renal and adrenal tumours are presented. Topics covered include a proposed revision to the staging of NBL, the problems inherent in distinguishing nephrogenic rests from Wilms' tumour and the current recently altered approach regarding small lung nodules in children with Wilms' tumour.
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Affiliation(s)
- Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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11
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Lindskog M, Spenger C, Klason T, Jarvet J, Gräslund A, Johnsen JI, Ponthan F, Douglas L, Nordell B, Kogner P. Proton magnetic resonance spectroscopy in neuroblastoma: Current status, prospects and limitations. Cancer Lett 2005; 228:247-55. [PMID: 15946794 DOI: 10.1016/j.canlet.2004.12.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
Non-invasive biological information about residual neuroblastoma tumour tissue could allow treatment monitoring without the need for repeated biopsies. Magnetic resonance spectroscopy (MRS) can be performed with standard MR-scanners, providing specific biochemical information from selected tumour regions. By proton 1H-MRS, lipids, certain amino acids and lactate can be detected and their relative concentrations estimated in vivo. Using experimental models of neuroblastoma, we have described the potential of 1H-MRS for the prediction of tumour tissue viability and treatment response. Whereas viable neuroblastoma tissue is dominated by the choline 1H-MRS resonance, cell death as a consequence of spontaneous necrosis or successful treatment with chemotherapy, angiogenesis inhibitors, or NSAIDs is associated with decreased choline content. Therapy-induced neuroblastoma cell death is also associated with enhanced 1H-MRS resonances from mobile lipids and polyunsaturated fatty acids. The mobile lipid/choline ratio correlates significantly with cell death and based on the dynamics of this ratio tumour regression or continued growth (drug resistance) after chemotherapy can be predicted in vivo. The implications of these findings are discussed with focus on the potentials and limitations of introducing 1H-MRS for clinical assessment of treatment response in children with neuroblastoma. Biochemical monitoring of neuroblastoma with 1H-MRS could enable tailoring of individual therapy as well as provide early pharmacodynamic evaluation of novel therapeutic modalities.
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Affiliation(s)
- Magnus Lindskog
- Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska Hospital, S-17176 Stockholm, Sweden.
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12
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Abstract
The natural history, biologic and histological features, and the presenting symptoms of neuroblastoma are reviewed. The radiological findings of this neurogenic paediatric tumour are discussed.
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Affiliation(s)
- Georgia Papaioannou
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
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13
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Schmied C, Santos R, Leinsinger G, Schmid I, Hahn K, Pfluger T. Bildgebende Diagnostik des kindlichen Neuroblastoms. Monatsschr Kinderheilkd 2005. [DOI: 10.1007/s00112-004-0913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Qualman SJ, Bowen J, Fitzgibbons PL, Cohn SL, Shimada H. Protocol for the examination of specimens from patients with neuroblastoma and related neuroblastic tumors. Arch Pathol Lab Med 2005; 129:874-83. [PMID: 15974810 DOI: 10.5858/2005-129-874-pfteos] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen J Qualman
- Department of Laboratory Medicine, Children's Hospital, Columbus, Ohio, USA.
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15
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Pirson AS, Krug B, Tuerlinckx D, Lacrosse M, Luyx D, Borght TV. Additional Value of I-123 MIBG SPECT in Neuroblastoma. Clin Nucl Med 2005; 30:100-1. [PMID: 15647675 DOI: 10.1097/00003072-200502000-00006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anne-Sophie Pirson
- Department of Nuclear Medicine, Mont-Godinne Medical Center, Université Catholique de Louvain Medical School, Belgium
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16
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17
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Abstract
Significant differences exist between the European and North American treatment protocols for Wilms' tumor and neuroblastoma. There are variations in biopsy technique, timing and extent of initial surgery, chemotherapy protocols and dosage routines, as well as the type of salvage therapy. With the consolidation of the two major North American study groups into a single entity (Children's Oncology Group), the European and North American study groups represent the only remaining large-scale venues for treatment comparison. It is important to study and understand the variation in treatment protocols in order to maintain an open forum of scientific investigation that will lead to improving the care and outcome of children with cancer. It is anticipated that the unification of the North American groups will lead to greater interest and scientific cooperation with the European study group. This paper will serve as a forum for such a discussion at a local level.
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Affiliation(s)
- B Z Morgenstern
- Department of Pediatric and Adolescent Medicine, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
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18
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Pfluger T, Schmied C, Porn U, Leinsinger G, Vollmar C, Dresel S, Schmid I, Hahn K. Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma. AJR Am J Roentgenol 2003; 181:1115-24. [PMID: 14500242 DOI: 10.2214/ajr.181.4.1811115] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Thomas Pfluger
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, D-80336 Munich, Germany
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Hahn K, Charron M, Shulkin BL. Role of MR imaging and iodine 123 MIBG scintigraphy in staging of pediatric neuroblastoma. Radiology 2003; 227:908; author reply 908-9. [PMID: 12773693 DOI: 10.1148/radiol.2273021240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Abstract
Neuroblastoma and Wilms' tumor are the most common noncentral nervous system solid tumors in children. Imaging plays a crucial role in the evaluation of the primary tumor and regional and metastatic disease. There is a growing body of literature supporting the use of MRI as the technique of choice for the evaluation of local and regional disease in children with suspected neuroblastoma; however, in children with suspected Wilms' tumor, MRI will likely continue to play a role as a problem-solver when the results of CT are equivocal or indeterminant.
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Affiliation(s)
- James S Meyer
- Department of Radiology, Jefferson Medical College, Philadelphia, PA 19104, USA.
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21
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Ramsden WH. Imaging in the diagnosis and staging of paediatric abdominal tumours. IMAGING 2001. [DOI: 10.1259/img.13.4.130262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Abstract
Neuroblastoma treatment remains challenging but has been advanced by the establishment of clinical and biological variables that determine prognostic risk. Risk-based therapy currently is the hallmark of neuroblastoma treatment. Initially, stage and age were the prime determinants of survival used in clinical practice. The Shimada histopathologic classification added to the former 2 and biochemical markers like the serum ferritin, lactic dehydrogenase, and neuron-specific enolase also provided information regarding prognosis. The current era of neuroblastoma therapy has been influenced heavily by advances in molecular biology, most notably the identification of the MYCN oncogene and the application of recombinant DNA methods to identification of chromosomal deletions. Current risk assessment includes age, stage, histopathology, and biochemical markers but also analyses performed on DNA extracted from fresh tumors. This places the onus of obtaining an adequate quantity and quality of fresh neuroblastoma tissue directly on the pediatric surgeon who performs the initial biopsy.
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Affiliation(s)
- M P La Quaglia
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10012, USA
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23
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Abstract
The incidence of neonatal adrenal tumors is increasing due to the expanded use and accuracy of prenatal ultrasonography in routine obstetric care. Although adrenal and juxtarenal masses may represent benign lesions (adrenal hemorrhage, subdiapragmatic extralobar pulmonary sequestration), the majority of masses either are premalignant or malignant. Previous algorithms for the diagnosis and management of these lesions have been guided primarily by the high incidence of neuroblastomas within this group. Improved insight into the relatively benign behavior of many neonatal neuroblastomas has stimulated debate regarding the appropriate management schema for neonatal adrenal masses. Moreover, the increasing recognition of benign juxtarenal lesions further challenges the conventional dogma. This review discusses the major categories of adrenal masses to help generate a rational algorithm for diagnosis and therapy.
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Affiliation(s)
- E P Nadler
- Department of Surgery, Children's Hospital of Pittsburgh, and the University of Pittsburgh School of Medicine, Pennsylvania 15213, USA
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