Preoperative computed tomography scanning for abdominal neuroblastomas is superior to magnetic resonance imaging for safe surgical planning

• Published in: Pediatric blood & cancer 2019-11, Vol.66 (11), p.e27955-n/a
• Main Authors: Burnand, Katherine, Barone, Giuseppe, McHugh, Kieran, Cross, Kate
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Neoplasms - diagnostic imaging; Abdominal Neoplasms - drug therapy; Abdominal Neoplasms - pathology; Abdominal Neoplasms - surgery; abdominal neuroblastoma; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Calcification; Chemotherapy; Child; Child, Preschool; Children; Combined Modality Therapy; Computed tomography; Contrast Media; Female; Fibrosis; Hematology; Humans; Infant; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Neoadjuvant Therapy; Neuroblastoma; Neuroblastoma - diagnostic imaging; Neuroblastoma - drug therapy; Neuroblastoma - pathology; Neuroblastoma - surgery; NMR; Nuclear magnetic resonance; Oncology; Pediatrics; Preoperative Care - methods; Resonance; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; surgical planning; Tomography; Tomography, X-Ray Computed - methods
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.27955

Background Cross‐sectional imaging is required to assess disease prior to surgery for neuroblastoma (NBL), and both magnetic resonance imaging (MRI) and computed tomography (CT) scan are considered acceptable. We had concerns that MRI was underestimating disease extent, so from early 2016 we have systematically used MRI and CT before all abdominal NBL resections. The aim of this retrospective study was to establish which imaging modality is more accurate in determining disease extent, particularly after chemotherapy. Methods Abdominal MRI and CT scans for all children with abdominal NBL referred for surgery from January 2016 to February 2018 were retrospectively reviewed to evaluate the extent of disease and the presence of imaging‐defined risk factors (IDRFs). Results Thirty‐one patients were eligible for consideration of surgery post disease reassessment with MRI/MIBG. Twenty‐four of 31 children were included. CT was performed a median of 15 (range, 1–47) days after MRI. MRI underestimated IDRFs compared with CT in 13 of 24 patients (54%). Seventeen of 24 patients underwent surgery, and operative findings had 100% correlation with CT imaging. Notably, there were fundamental changes in management post CT in 6 of 24 patients (25%). CT did not underestimate disease compared with MRI in any patient. Conclusion MRI underestimated the extent of the disease in half of our patients considered for NBL resection. This may be due in part to tumor fibrosis, calcification, and chemotherapy. Preoperative CT scan is the best imaging modality to identify all IDRFs after chemotherapy to ensure safe surgery.