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Neuroblastoma: A Disease Requiring a Multitude of Imaging Studies*

Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York

View larger version (113K): [in a new window]   FIGURE 1. MRI of large-stage 2A paraspinal neuroblastoma with epidural extension ("dumbbell") causing paraplegia in infant. Paraparesis was still present 34 mo after partial tumor resection.

View larger version (88K): [in a new window]   FIGURE 2. CT image of abdominal neuroblastoma compressing right kidney in nearly 3-y-old child who presented with convulsion from malignant hypertension. Patient is in remission from stage 4 disease 28+ mo later.

View larger version (99K): [in a new window]   FIGURE 3. CT image of cervical neuroblastoma causing Horner’s syndrome. Tumor was only partially resected to avoid damage to brachial plexus. Residual tumor spontaneously regressed but Horner’s syndrome was still present 8+ y later.

View larger version (90K): [in a new window]   FIGURE 4. One-month-old child with life-threatening abdominal distension from massive liver involvement (stage 4S). Patient was treated with 1 cycle of chemotherapy and is disease-free 7+ y later.

View larger version (109K): [in a new window]   FIGURE 5. CT of neonate showing diffuse infiltration of liver with multiple focal low-density lesions treated emergently with radiotherapy (400 cGy). A small right adrenal mass spontaneously resolved and patient is well at age 49 mo.

View larger version (126K): [in a new window]   FIGURE 6. CT image of enormous abdominal mass in 5 y old with stage 4 neuroblastoma. Tumor shrank with chemotherapy and was successfully resected. Patient is in complete remission 16+ mo later.

View larger version (103K): [in a new window]   FIGURE 7. CT image of large abdominal neuroblastoma in 13-mo-old child. Mass crossed midline and encased major blood vessels—findings typical for high-risk neuroblastoma. However, mass (and regional lymph nodes) proved to be resectable, making this stage 2B, as previously described (29). Patient remains well 9+ y later without having received any cytotoxic therapy.

View larger version (84K): [in a new window]   FIGURE 8. CT image of large pelvic neuroblastoma with regional nodal involvement (stage 2B) in 17-mo-old girl. All visible disease was resected.

View larger version (81K): [in a new window]   FIGURE 9. CT image of recurrent thoracic neuroblastoma that caused respiratory distress in 3-y-old child, who in infancy had stage 4S that had spontaneously resolved. Recurrence was resected, as previously described (29). Patient is well 10+ y later without ever having received cytotoxic therapy.

View larger version (103K): [in a new window]   FIGURE 10. CT image of large abdominal neuroblastoma (A) in 15-mo-old child who also had left supraclavicular tumor (B), but no involvement of cortical bone or bone marrow (stage "IV-N"). Abdominal mass was resected, biologic markers were favorable, and no cytotoxic therapy was administered. Distant disease spontaneously regressed, and child is well 4+ y later.

View larger version (79K): [in a new window]   FIGURE 11. Abdominal MRI in 3-mo-old child with unresectable retroperitoneal neuroblastoma (A) and hepatic lesions (B). Extent of disease was poorly defined using CT. All masses and bone marrow disease spontaneously regressed.

View larger version (107K): [in a new window]   FIGURE 12. 123I-MIBG image of 10-mo-old child with posterior mediastinal primary tumor, extensive bone marrow involvement, and bulky metastatic deposits in right parietal skull and left sphenoid/orbit, but no MYCN amplication and therefore prognosis is favorable.

View larger version (86K): [in a new window]   FIGURE 13. 123I-MIBG image of 3-y-old child with left adrenal primary tumor, extensive bone marrow involvement, and large soft-tissue metastatic deposits in right superior mediastinum and right supraclavicular region. Patient is in remission at 30+ mo.

View larger version (93K): [in a new window]   FIGURE 14. 123I-MIBG image of newly diagnosed 13-y-old child with soft-tissue disease in neck, mediastinum, abdomen, and pelvis; bulky metastatic lesion involving cranial bones; and extensive bone marrow involvement. This adolescent achieved complete remission but later relapsed.

View larger version (99K): [in a new window]   FIGURE 15. 123I-MIBG image of 3-y-old child with no definite evidence of disease but with false positivity in left adrenal gland (contralateral adrenal gland was previously resected), in bowel (over left pelvis and superior to bladder), and bilaterally in upper chest.

View larger version (94K): [in a new window]   FIGURE 16. 123I-MIBG image of 8-y-old child with widespread relapsed disease that did not respond to chemotherapy. Treatment with 666 MBq/kg (18 mCi/kg) of 131I-MIBG achieved a complete remission; follow-up 123I-MIBG scintigraphy showed no abnormal uptake.

View larger version (66K): [in a new window]   FIGURE 17. FDG PET image of 21-y-old adult with extensive bone marrow involvement. Patient is in remission at 32+ mo.