Bilateral adrenal calcification was identified in a neonate at 7 weeks of age following Herpes Simplex Type I infection at 2 weeks of age. Calcification could be identified by plain films and ultrasound. Extensive hepatic calcification was also noted.

Two patients with IVC and right atrial tumor thrombus associated with malignant bone tumors are described. Other tumors such as Wilms', renal cell CA, testicular adrenal and hepatic neoplasms have also been reported to invade the IVC. Ultrasound, CT and MRI are helpful in evaluating the presence of vascular thrombosis as well as its longitudinal extent, and intracardiac involvement.

The purpose of this study was to determine the frequency with which magnetic resonance (MR) imaging detects avascular necrosis of the bone (AVNB) in children with acute lymphoblastic leukemia (ALL) or advanced-stage non-Hodgkin lymphoma (NHL) who receive prednisone during remission induction, reinduction, and maintenance chemotherapy; to assess the clinical significance of these findings; and to identify factors predictive of AVNB. We prospectively obtained MR imaging of the hips and knees of 116 children who had completed at least 1 year of treatment for ALL or advanced-stage NHL on identical prednisone-containing regimens between December 1991 and October 1994. MR imaging findings of AVNB were compared with clinical outcomes, and the effect of therapeutic and patient factors on the frequency of AVNB was analyzed. The MR imaging findings of 17 of the 116 participating patients were consistent with AVNB. The most common clinical manifestation was joint pain (11 patients). Only one patient had progressive joint deterioration that necessitated surgical replacement. Only age 10 years or more at the time of the primary diagnosis was significantly associated with the development of AVNB ( P = 0.004). MR imaging showed changes consistent with AVNB in approximately 15% of this patient population. However, most patients in this study who had MR imaging signs of AVNB did not experience progressive joint destruction, even with continued prednisone therapy. Therefore, the clinical usefulness of MR imaging as a screening tool for AVNB in this set of patients remains uncertain.

PURPOSE:To determine the activity of carboplatin/ifosfamide in patients with previously untreated osteosarcoma and to estimate patient outcomes after a multiagent chemotherapy protocol that eliminated cisplatin.PATIENTS AND METHODS:Sixty-nine patients with newly diagnosed, previously untreated osteosarcoma received three cycles of carboplatin (560 mg/m(2) x 1) and ifosfamide (2.65 g/m(2)/d x 3). Assessment of response was evaluated after two (week 6) and three (week 9) chemotherapy cycles. At week 9, histologic response was assessed. Adjuvant therapy comprised two additional carboplatin/ifosfamide cycles, doxorubicin, and high-dose methotrexate. Patients were stratified at enrollment: stratum A, resectable primary tumor without metastases; stratum B, unresectable primary tumor; and stratum C, metastatic disease at diagnosis. Week 6 response was compared with that of a historic group that received only ifosfamide during the initial window evaluation.RESULTS:The clinical and radiographic response rate to three cycles of carboplatin/ifosfamide was 67.7% (95% confidence interval, 55.0% to 78.8%). Compared with the historic population who received only ifosfamide, the combination of carboplatin and ifosfamide reduced the progressive disease rate at week 6 (31.9% v 9%, P: = .003). For patients in stratum A, the 3-year event-free survival and survival were 72.3% +/- 6.7% and 76.4% +/- 6.4%, respectively. Patients who received carboplatin-based therapy had less long-term renal toxicity and ototoxicity.CONCLUSION:This pilot trial suggests that carboplatin/ifosfamide combination chemotherapy has substantial antitumor activity. In the context of a multiagent chemotherapy protocol comprising high-dose methotrexate and doxorubicin, we found that the addition of carboplatin/ifosfamide resulted in patient outcomes comparable to trials using cisplatin-based therapy with less long-term toxicity.

BACKGROUND. The purpose of this article was to evaluate the utility of a pharmacokinetically modeled measure of regional contrast access, based on dynamic contrast-enhanced magnetic resonance imaging (MRI) studies after preoperative chemotherapy, as a predictor of disease free survival in osteosarcoma.METHODS. The kinetic parameters of a two-compartment pharmacokinetic model of MRI contrast agent accumulation were analyzed in relation to disease free survival in 31 patients who received protocol-based therapy for nonmetasratic osteosarcoma of the extremities. The modeled exchange rate of contrast between the plasma and the tumor extravascular extracellular fluid space served as a measure of regional contrast access. The prognostic impact of both the clinically accepted standard of histologic evaluation of tumor necrosis and the regional contrast access were analyzed with tumor size as an influential factor.RESULTS. Although the histologic grade of response was not a statistically significant prognostic factor in these patients (P = 0.884), regional contrast access after preoperative chemotherapy was significantly predictive of disease free survival (P = 0.035) in the Cox proportional hazards model. Lower regional access before surgery and smaller tumor size were associated with a better treatment outcome. Log-rank analyses of Kaplan-Meier curves indicated that the impact of regional access was most pronounced in patients with larger tumors (P = 0.052). Higher regional access at presentation also was associated significantly with greater decreases during therapy.CONCLUSIONS. Dynamic MRI estimates of regional contrast access after preoperative chemotherapy, when combined with tumor size, holds promise for the early identification of patients at risk of recurrence. The availability of such response predictors could facilitate the development of risk-adapted treatment approaches. (C) 2001 American Cancer Society.

BACKGROUND:Adrenocortical carcinoma (ACC), a tumor that is rare among children, causes clinically evident hormonal disturbances. Imaging methods are used to stage disease and to plan surgical resection.OBJECTIVE:To describe the findings of the various imaging methods used to evaluate ACC.MATERIALS AND METHODS:We reviewed the records of ten consecutive patients (mean age, 8.1 years) who presented from 1987 to 1998 with ACC. All patients underwent computed tomography (CT) scanning; five underwent magnetic resonance (MR) imaging; four underwent ultrasonography (US); and eight underwent radionuclide bone scans.RESULTS:Seven patients presented with signs of hormonally functional tumors. Typical imaging findings consisted of a large, well-defined suprarenal tumor, containing calcifications (seven patients) with a thin capsule and central necrosis or hemorrhage (six patients). The inferior vena cava (IVC) was compressed by tumor in three patients, and ultrasonography demonstrated invasion of the IVC wall in one of these. Three patients' bone scans showed that the primary tumor took up radioactive tracer. Spread to lungs or liver or both was demonstrated in six patients.CONCLUSIONS:CT, US and MR imaging are effective methods of imaging the primary tumor. Chest CT and bone scintigraphy should be performed to detect metastases. The presence of a thin tumor capsule, a stellate central zone of necrosis, and evidence of hormonal function help distinguish ACC from neuroblastoma.

Malignant mesothelioma is a rare tumor in childhood. We present two cases of malignant peritoneal mesothelioma in which contrast-enhanced, fat-saturated magnetic resonance (MR) imaging was used advantageously to detect peritoneal tumor involvement.

PURPOSE:Computed tomography (CT) scans of the neck and chest are obtained at diagnosis of Hodgkin's disease to establish disease extent, plan radiotherapy, and serve as baseline studies for subsequent evaluation of response to therapy. However, differences in interpretation may occur even among experienced radiologists. This study was designed to test the extent of variation among expert radiologists' interpretations and to assess how their interpretations differed from that of the primary (institutional) radiologists.MATERIALS AND METHODS:Five radiologists independently reviewed randomly selected CT scans of 59 patients enrolled onto two Pediatric Oncology Group Hodgkin's disease treatment protocols. For each patient, 31 potential disease sites were scored as positive, negative, uncertain, or unassessable. Agreement among the reviewers and between the reviewers and the primary readers was analyzed.RESULTS:For 58% of the sites, at least four of the five reviewers agreed in >/= 80% of the cases. Kappa analysis showed moderate agreement in approximately two thirds of the sites and poor agreement in the remainder. There was moderate agreement between a majority of the expert readers and the primary radiologist reports for approximately one third of the sites, and agreement was poor in two thirds.CONCLUSION:There are disparities among radiologists' interpretations of cervical-thoracic CT imaging of patients with Hodgkin's disease. This variability may affect patient care and the performance and results of multi-institutional clinical trials. We propose that a standardized method of reporting might improve the consistency of interpretation of CT scans in these patients.

If chemotherapy is to be effective against bone sarcoma, the cytotoxic agents must reach all tumor cells in effective quantities. Although many clinical trials include studies of the pharmacokinetics of these agents in blood or cerebrospinal fluid, there have been no accurate or widely applicable methods of determining whether chemotherapeutic agents reach all regions of a solid tumor. This review discusses the use of dynamic contrast‐enhanced magnetic resonance imaging (DEMRI) to assess the microcirculation and interstitium of bone sarcoma. DEMRI studies provide a means of exploring leakage of contrast agent into tumor interstitium (extracellular extravascular spaces [EES]). In clinical observations of numerous series of patients with bone sarcoma, measures of contrast uptake (access) have convincingly demonstrated a relationship with measures and predictions of the tumor's response to preoperative chemotherapy. The results of these studies have indicated that greater access at the time of presentation, greater decrease in access during therapy, and low access at the completion of preoperative therapy correspond to better response and longer disease‐free survival. Although questions remain about how these novel dynamic imaging methods can best be used to measure drug access noninvasively, we are optimistic that such measures can be developed to reflect the range of biological variation within and between naturally occurring solid tumors. J. Magn. Reson. Imaging 1999;10:277–285. © 1999 Wiley‐Liss, Inc.

PURPOSE:To compare thallium-201 scintigraphy with gallium-67 scintigraphy in the detection of residual or recurrent mediastinal Hodgkin disease after treatment.MATERIALS AND METHODS:The authors performed planar Ga-67 and Tl-201 scintigraphy in 39 patients aged 7-18 years (27 with mediastinal primary disease) after primary treatment. These scans and those in a control group of 14 patients with newly diagnosed known mediastinal Hodgkin disease were evaluated independently by two radiologists for abnormal mediastinal activity. Results were compared with chest computed tomographic (CT) findings and with the clinical criteria of disease status. Interobserver agreement and consensus agreement on gallium and thallium scan findings were evaluated with the kappa statistic, and the specificity of the two imaging methods was analyzed.RESULTS:All study patients were judged to be free of mediastinal disease with CT and the clinical criteria. Interobserver agreement on findings in the treated and control patients was stronger with gallium scintigraphy (kappa +/- SD = 0.956 +/- 0.044) than with thallium scintigraphy (kappa = 0.638 +/- 0.110). Specificity of ratings based on thallium (85% +/- 6) and gallium (90% +/- 5) scintigraphic findings of mediastinal disease did not differ significantly (P = .48). Specificity improved when the results of the two examinations were combined (97% +/- 2).CONCLUSION:Thallium scintigraphy can help to predict the absence of mediastinal Hodgkin disease after treatment.

We report three patients who developed severe supraglottic airway obstruction due to Epstein-Barr virus lymphoproliferative disease following allogeneic bone marrow transplantation. In addition to enlarged pharyngeal lymphoid tissue seen in all three patients, two had supraglottic airway narrowing and two developed pulmonary lymphoproliferative disease. They were treated with unmanipulated T cells or EBV-specific cytotoxic T lymphocytes. Life-threatening upper airway obstruction is a radiologically detectable complication of allogeneic bone marrow transplantation in children.

The treatment of pediatric bone malignancies has undergone dramatic change in the past two decades. With the use of adjuvant chemotherapy, survival of patients with osteosarcoma and Ewing's sarcoma has greatly increased and most extremity lesions are now managed with an initial course of chemotherapy followed by limb-sparing surgery rather than amputation. Radiologists are called on not only to help diagnose and stage these tumors, but also to assess their extent, to determine response to preoperative chemotherapy, and to monitor patients for postoperative complications and recurrent disease. This article discusses imaging solutions to clinical issues that arise during the care of these children.

This review discusses the effects of treatment of pediatric malignancies on the musculoskeletal system with an emphasis on plain radiographic and MR imaging findings following radiation therapy, chemotherapy, bone marrow transplantation and hematopoietic growth factor administration.

To assess contrast-enhanced (C+), fat-saturated (FatSat), T1-weighted (TIW) imaging in the characterization of the soft tissue mass associated with primary bone tumors, we compared it with T2-weighted (T2W) imaging in patients with osteosarcoma (n = 36) and Ewing sarcoma family of tumors (Ewing sarcoma; n = 11), Periosseous tumor compared with normal muscle had greater contrast-to-noise ratio (CNR) on the FatSat T1W C+ image than on T2W for 81% (38/47; P<.0001) of patients. The CNR of periosseous tumor compared with subcutaneous fat was greater on FatSat T1W C+ for 98% (46/47; P <.0001), Radiologists found it easier to evaluate neurovascular bundle proximity to tumor with FatSat T1W C+ Images than with T2W for 64% of patients (30/47; P <.0001). They judged FatSat TIW C+ superior to T2W for periosseous tumor conspicuity and visualization of soft tissue necrosis in 62% (29/47; P <.0001). In patients with osteosarcoma or Ewing sarcoma, FatSat T1W C+ imaging may replace T2W imaging for soft tissue mass evaluation, especially if contrast is being used for dynamic enhancement.

HomeRadiologyVol. 200, No. 3 PreviousNext LettersDynamic MR Imaging of Musculoskeletal NeoplasmsBarry D. Fletcher, Wilburn E. Reddick, June S. TaylorBarry D. Fletcher, Wilburn E. Reddick, June S. TaylorAuthor AffiliationsDepartment of Diagnostic Imaging, St Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105-2794Barry D. FletcherWilburn E. ReddickJune S. TaylorPublished Online:Sep 1 1996https://doi.org/10.1148/radiology.200.3.869-bMoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: Sept 1996 FiguresReferencesRelatedDetailsCited ByPreliminary Experience Using Dynamic MRI at 3.0 Tesla for Evaluation of Soft Tissue TumorsMichael YongPark, Won-HeeJee, Sun KiKim, So-YeonLee, Joon-YongJung2013 | Korean Journal of Radiology, Vol. 14, No. 1In vivo characterisation of soft tissue tumours by 1.5-T proton MR spectroscopyF.Russo, S.Mazzetti, G.Grignani, G.De Rosa, M.Aglietta, G. C.Anselmetti, M.Stasi, D.Regge2012 | European Radiology, Vol. 22, No. 5Longitudinally Monitoring Chemotherapy Effect of Malignant Musculoskeletal Tumors With In Vivo Proton Magnetic Resonance SpectroscopyTsyh-JyiHsieh, Chun-WeiLi, Hung-YiChuang, Gin-ChungLiu, Chien-KuoWang2008 | Journal of Computer Assisted Tomography, Vol. 32, No. 6Characterization of Bone and Soft-Tissue Tumors with in Vivo 1H MR Spectroscopy: Initial Results1Chien-Kuo Wang, , Chun-Wei Li, , Tsyh-Jyi Hsieh, , Sang-Hsiung Chien, , Gin-Chung Liu, , and Kun-Bow Tsai, 1 August 2004 | Radiology, Vol. 232, No. 2Evaluation of angiogenesis and perfusion of bone marrow lesions: Role of semiquantitative and quantitative dynamic MRIHansHawighorst, MartinLibicher, Michael V.Knopp, ThomasMoehler, G.W.Kauffmann, Gerhard vanKaick1999 | Journal of Magnetic Resonance Imaging, Vol. 10, No. 3Medical RadiologyA. M.Davies, D.Vanel1998IMAGING PEDIATRIC BONE SARCOMASBarry D.Fletcher1997 | Radiologic Clinics of North America, Vol. 35, No. 6Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 200, No. 3 Metrics Altmetric Score PDF download

OBJECTIVE:We compared how well T1-weighted and short inversion time inversion recovery (STIR) MR images obtained before and after preoperative chemotherapy reveal the extent of longitudinal intraosseous tumor involvement in osteosarcoma of children.MATERIALS AND METHODS:MR images were obtained at diagnosis and after preoperative multiagent chemotherapy in 20 children with osteosarcoma arising in the long bones. Images were reviewed to determine the length of the abnormal intraosseous signal intensity on paired longitudinal T1-weighted and STIR images taken at diagnosis and after chemotherapy. These measurements were compared with those made during a review of similarly oriented pathologic sections of the resected bone. Median differences were calculated and analyzed using Wilcoxon's signed-rank test.RESULTS:Abnormalities detected on T1-weighted images corresponded more closely to pathologic findings than did abnormalities detected on STIR images. On STIR images, readers overestimated tumor extent in 73% of both pre- and postchemotherapy studies. Readers overestimated tumor length on 29 of the 40 STIR images and on 13 of the 40 T1-weighted images. Readers underestimated tumor length on five STIR images and 11 T1-weighted images. Median differences between measurements made at the pathologic examination and on STIR images were statistically significant, both for imaging at diagnosis (p = .001) and for imaging after chemotherapy (p = .005); however, no significant differences were found between measurements made at the pathologic examination and measurements made on T1-weighted images. Measurements of tumor length on either type of imaging did not change significantly after chemotherapy. MR imaging showed 100% sensitivity for epiphyseal tumor spread but poor specificity. False-positive readings occurred in seven of 13 patients with abnormal signal intensity that extended into the adjacent epiphyses.CONCLUSION:Readers estimated intraosseous tumor extent more accurately on T1-weighted images than on STIR images. Readers overestimated tumor length on STIR images. T1-weighted longitudinal images taken before chemotherapy can be used for early planning of surgical approaches to osteosarcoma in children.

PURPOSE:To evaluate the usefulness of thallium-201 scintigrams in depiction of supradiaphragmatic lymphadenopathy associated with newly diagnosed Hodgkin disease in pediatric patients.MATERIALS AND METHODS:Thallium-201 and gallium-67 scans of the chest and neck were obtained in 33 consecutive patients. Mediastinal, cervical, supraclavicular, and axillary lymph node activity was evaluated by independent raters, and results were compared in a blinded fashion with those on chest computed tomographic (CT) scans.RESULTS:Gallium and thallium scans demonstrated similar accuracy in depiction of CT-defined mediastinal masses. The kappa statistic indicated moderate to strong agreement with CT results. Similarly, there was no statistically significant difference between the accuracy of thallium and gallium scans in depiction of extramediastinal lymphadenopathy.CONCLUSION:Thallium scintigraphy is effective for depiction of lymphadenopathy in pediatric patients with untreated Hodgkin disease. Serial thallium studies may provide an alternative to gallium scans in monitoring response to treatment.