What is the role of imaging studies in the workup of pediatric neuroblastoma?

Updated: Oct 09, 2017
  • Author: Norman J Lacayo, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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The following studies may be indicated in patients with neuroblastomas:

  • Obtain chest and abdominal radiographs to evaluate for the presence of a posterior mediastinal mass or calcifications.

  • A CT scan of the primary site is essential to determine tumor extent. The main body of the tumor is usually indistinguishable from nodal masses. See the images below.

    CT scan of abdomen in a patient with a retroperito CT scan of abdomen in a patient with a retroperitoneal mass arising from the upper pole of the left kidney and elevated urine catecholamines.
    A one-week-old neonate had abdominal ultrasonograp A one-week-old neonate had abdominal ultrasonography for evaluation of projectile vomiting. A right adrenal mass (100% cystic) was an incidental finding. Evaluation of the mass by CT was consistent with an adrenal bleed (3.6 x 3.1 x 2.4 cc). The infant was followed at 2 weeks (2-dimensional size diminished to 1.5 x. 2.4 cm2 on ultrasonography) and then at 6 weeks to document that the adrenal bleed continued to involute. Urine catecholamines were normal.
  • In cases of paraspinal masses, MRI aids in determining the presence of intraspinal tumor and cord compression. Horner syndrome should be evaluated with an MRI of the neck and head. See the image below.

    MRI of a left adrenal mass. The mass was revealed MRI of a left adrenal mass. The mass was revealed by fetal ultrasonography at 30 weeks' gestation. During infancy, the mass was found on the inferior pole of the left adrenal and was completely resected. Before surgery, the metastatic workup was negative. Surgical pathology service confirmed a diagnosis of neuroblastoma. After 3 years of follow-up care, no recurrence was observed.
  • I123/131 -methyliodobenzylguanadine (MIBG) accumulates in catecholaminergic cells and provides a specific way of identifying primary and metastatic disease if present. Increasing numbers of institutions have access to MIBG scanning.

  • A technetium-99 bone scan can also be used to evaluate bone metastases. This may be especially helpful in patients with negative MIBG study findings. Most current therapeutic protocols require both a bone scan and MIBG scan.

  • Skeletal surveys may also be useful, especially in patients with multiple metastatic lesions.

  • Positron emission tomography (PET) scan are under evaluation but are not currently recommended as part of the radiographic workup.

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