Special Articles

4. Imaging of complication after treatment of advanced neuroblastoma

Osamu Miyazaki
Department of Radiology, National Center for Child Health and Development

Abstract

　　This review article depicts a variety of imaging of complications after surgery, radiation therapy, and chemotherapy in the pediatric patients who had survived advanced neuroblastoma. From the point of view of surgical treatment, higher incidence of late morbidity and treatment-associated mortality appeared to be more strongly related to disease stage than to patient age. The critical sequelae after surgical treatment are renal problems including renal artery stenosis and consequent renovascular hypertension.
　　It is well known that bony deformity has occurred after local radiation therapy, and deformity of the thoracolumbar spine and scoliosis are common problems after local radiation therapy for adrenal neuroblastoma. Also, we radiologist should know the side effects of total body irradiation (TBI) for the preconditioning of bone marrow treatment (BMT). The skeletal alterations on radiographs were abnormal epiphyseal ossification and metaphyseal fraying, longitudinal metaphyseal striations, irregular metaphyseal sclerosis, osteochondroma, slipped capital femoral epiphysis and spinal abnormality. The spinal changes presented as spondyloepiphyseal dysplasia such as platyspondyly and mild thoracolumbar gibbus. These systemic bony changes after TBI mimic skeletal dysplasia.
　　In the central nervous system, both chemotherapy and radiation therapy can induce leukoencephalopathy. Cyclosporine and some other chemotherapy agents carry a risk of potentially reversible encephalomalacia (PRES). MR imaging may reveal characteristic focal wedge-shaped abnormalities that show enhancement in gray matter or white matter in the posterior, frontal, and temporal lobes.
　　Prolonged neutropenia is a major risk factor for fungal infections such as those due to aspergillus. Airspace opacification and parenchymal nodules with halos of ground-glass attenuation are a common CT appearance.
　　Radiologists have a role in detecting these sequlae and complications involving all organ systems.

Keywords：Neuroblastoma, Complication, Pediatric radiology