Twenty patients with biopsy-proven osteogenic (11 cases) or Ewing's (nine cases) sarcoma were evaluated by MR imaging on a 0.15-T resistive unit to determine the value of MR in the diagnosis and treatment of these two neoplasms and to develop the best protocol for MR imaging. In all 20 cases, MR identified tumor spread into bone marrow, and it was superior to CT in five cases. Extension of tumor into the soft tissues adjacent to bone was shown better by MR than CT in six cases. Improved anatomic information from MR is the result of the ability to image in the axial, coronal, and sagittal planes. Compared with CT, MR identifies cortical disease but has inferior spatial resolution and defines calcium poorly. MR can be used to monitor tumor response to chemotherapy, and the relationship of tumor to adjacent vasculature can be determined without the use of contrast agents. Two pulse sequences are necessary for maximum display of disease, since, in general, tumor involvement of the bone marrow is best assessed on T1-weighted sequences, and tumor involvement of the soft tissue is best seen on T2-weighted sequences. Additional information about bone-marrow involvement, soft-tissue tumor extent, and the relationship of tumor to blood vessels makes MR a valuable adjunct to CT in the evaluation of these neoplasms.

If costs of medical care are to be reduced, the choice of which imaging modality to use must be made as carefully as possible. This study was done to show how radiological modalities were used to evaluate patients with Hodgkin disease and non-Hodgkin lymphoma. We kept a record of every radiological study performed on 66 children with both diseases seen in the past 6 1/3 years. The results of these studies were analyzed to see which areas of the body were studied, which imaging modality was used, how frequently the studies were repeated, and how frequently the studies gave abnormal results. Our findings disclosed that radiological studies have been appropriately performed in anatomic regions of the body in which disease is present. New imaging modalities have been introduced, and the use of some of the older modalities has been decreased. With some modalities, such as skeletal survey, liver/spleen scan, whole-lung tomography, contrast studies of the bowel, and excretory urography, utilization is higher than it ought to be in view of the fact that the yield of positive results is low and the information is obtainable in many cases from other more sensitive procedures. These studies should not be performed as a routine on initial evaluation or follow-up of all patients with Hodgkin or non-Hodgkin lymphomas. On initial presentation all patients should undergo chest radiography and CT scanning of both chest and abdomen. A problem area is that the timing of follow-up studies has been somewhat erratic, with some inappropriate studies particularly 3 or 4 years after diagnosis. Too many imaging procedures have probably been done in follow-up of our patients.

Magnetic resonance imaging has been used to evaluate 10 children with lymphomas and was able to identify disease in all 10 cases and monitor response to therapy in all three patients with follow-up studies. It could not distinguish between the different histological types of lymphoma. The image intensity of a diseased spleen in one case was different from that of five other normal spleens in six children with Hodgkins disease. Magnetic resonance imaging compared well with computed tomography and it was especially good at identifying blood vessels.

Sixty-six percent of 54 patients with neuroblastoma demonstrated uptake of bone-seeking radioagents by the primary tumor. This is a higher incidence than previously reported. Uptake was slightly more common in abdominal than thoracic tumors. There was a significant correlation between the size of the tumor and tracer uptake. Calcification was demonstrated in the primary tumor in almost 90% of the 54 patients. This is a much higher incidence of calcification than previously reported. Microscopy shows that the calcification is not always due to tumor necrosis; it also occurs in areas of viable tumor cells. Tracer uptake is believed to be related to calcium metabolism. The rate of metabolic activity rather than the total amount of calcium present within the tumor may be the most important factor in determining the amount of uptake. No significant relationship was found between tracer uptake and tumor stage or homovanillic acid and vanillylmandelic acid metabolic activity.

Bone scans, bone-marrow scans, and radiographic skeletal surveys have been reviewed in 40 children with neuroblastoma. Bone scans are the most sensitive method for detecting metastases and should be used first. The additional yield from a skeletal survey is very small, so it should be done only if the bone scan is negative and major therapeutic decisions are to be made. Bone-marrow scans provide a sensitive method of identifying metastases, and may help in staging a patient as stage IV when the bone scan is negative.

Magnetic resonance imaging (MRI) in nine children with neuroblastoma showed that MRI can effectively demonstrate primary and metastatic disease and aid in predicting tumor resectability. MRI can show changes in tumor size and intensity in response to chemotherapy or radiation therapy. Neuroblastomas have an image intensity much lower than that of liver and muscle on inversion-recovery scans. On spin-echo 500/30 scans, the tumors have a greater intensity than muscle and a similar or slightly greater intensity than liver. On spin-echo 1000/60 scans, they are always of greater intensity than liver or muscle. At this stage, the overall accuracy of MRI as compared with other imaging methods is not known.

It is essential to recognize radiation pneumonitis after whole lung irradiation, or nodular changes in response to chemotherapy, so that such conditions are not mistaken for tumor metastases, causing grave error in patient management and the possibility of further lung damage.

HomeRadiologyVol. 141, No. 2 PreviousNext Pulmonary pseudometastases in children with malignant tumors.M Cohen, W L Smith, R Weetman, A ProvisorM Cohen, W L Smith, R Weetman, A ProvisorM CohenW L SmithR WeetmanA ProvisorPublished Online:Nov 1 1981https://doi.org/10.1148/radiology.141.2.7291560MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1981 FiguresReferencesRelatedDetailsCited ByRevista do Colégio Brasileiro de Cirurgiões, Vol. 45, No. 3Pediatric Blood & Cancer, Vol. 63, No. 4Pediatric Blood & Cancer, Vol. 59, No. 4European Journal of Cancer, Vol. 48, No. 7Journal of Pediatric Surgery, Vol. 46, No. 4Pediatric Radiology, Vol. 40, No. 6Pediatric Radiology, Vol. 39, No. S3Pulmonary Manifestations of Hematologic and Oncologic DiseasesPulmonary tuberculosis misdiagnosed as lung Metastasis in childhood cancer patientsKorean Journal of Pediatrics, Vol. 52, No. 8Pediatric Radiology, Vol. 38, No. 1Surgical Oncology, Vol. 16, No. 3Distinguishing Benign from Malignant Pulmonary Nodules with Helical Chest CT in Children with Malignant Solid Tumors1M. Beth McCarville, , Henrique M. Lederman, , Victor M. Santana, , Najat C. Daw, , Stephen J. Shochat, , Chin-Shang Li, , and Robert A. Kaufman, 1 May 2006 | Radiology, Vol. 239, No. 2Journal of Pediatric Surgery, Vol. 41, No. 1Medical and Pediatric Oncology, Vol. 38, No. 2Journal of Clinical Oncology, Vol. 20, No. 12International Journal of Radiation Oncology*Biology*Physics, Vol. 44, No. 3Pediatric Endosurgery & Innovative Techniques, Vol. 2, No. 2Pediatric Hematology and Oncology, Vol. 14, No. 4Hematology/Oncology Clinics of North America, Vol. 9, No. 6Radiologic Clinics of North America, Vol. 31, No. 3Pediatric Radiology, Vol. 22, No. 4Urologic radiology, Vol. 14, No. 1Pediatric Clinics of North America, Vol. 38, No. 2Cancer, Vol. 64, No. 4Update on pediatric chest imagingPediatric Pulmonology, Vol. 5, No. 3Clinical Radiology, Vol. 39, No. 6The Journal of Thoracic and Cardiovascular Surgery, Vol. 94, No. 2Pediatric Radiology, Vol. 16, No. 1, Vol. 19 / 6Cancer, Vol. 54, No. 6Journal of Pediatric Surgery, Vol. 19, No. 2Chest, Vol. 83, No. 5Cancer, Vol. 50, No. 5Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 141, No. 2 Metrics Downloaded 12 times Altmetric Score PDF download

Whole lung, frontal tomography is compared with frontal chest radiography in the diagnosis of pulmonary metastasis in children with cancer. Of 79 patients studied, 65 had a total of 195 routine tomograms. In only 2.7% of studies did tomography yield new information, and in only 1% was an additional lesion visualized. In 27 patients, tomography was performed after an abnormality was seen on the chest radiograph. New information was obtained in 15 (32%) of those 47 studies; additional nodules were identified on six occasions (four metastatic, two inflammatory), but only once was treatment altered. In one study, tomography localized a nodule seen only on a lateral chest radiograph, and in eight studies it excluded metastasis following an abnormal frontal chest radiograph.