Neuroblastoma (image-defined risk factors)

Image-defined risk factors are imaging features seen at the time of neuroblastomadiagnosis that confer a poorer prognosis. In 2009 theThe International Neuroblastoma Risk Group (INRG) suggested an update (2009) to the neuroblastoma staging of neuroblastoma with a listslist of features that, if present, upstageupstages a patient with local disease from L1 to L2.

Crossing/Extending:

• Fromfrom one compartment to another (eg;(e,g. chest to neck, abdomen to chest, abdomen to pelvis)
• Through through sciatic notch/foramen

Encasing Vessels:

• Carotid a.carotid artery
• Vertebral a.vertebral artery
• IJVinternal jugular vein
• Subclavian a.subclavian artery/vein
• aorta
• superior or v.inferior vena cava
• Aortacoeliac artery
• SVC or IVC
• Coeliac a.
• SMA (inc.superior mesenteric artery (including branches at the mesenteric root)
• Iliac a.iliac artery or v. vein

Compressing:

• Tracheatrachea
• Primaryprimary bronchi

Encasing Nerves:

• Roots of brachial plexus roots

Invading and Infiltrating:

• Toto skull base
• Intointo spinal canal. Defined - defined as;
  • >1/3 of canal involved on an axial section
  • Perimedullaryperimedullary leptomeningeal space not visablevisible
  • Signalsignal change in the adjacent spinal cord
• Costovertebralcostovertebral junction from T9-T12
• Portaporta hepatis,  hepatoduodenal ligament or liver
• Renalrenal pedicle or kidney
• Pericardiumpericardium
• Duodenopancreaticduodenopancreatic block
• Mesentarymesentary

• Encasement - Inencasement: in contact with >50% (a.(artery or v.vein) or completely occluding a vein (n.b. (<50% is 'contact'. Incomplete"contact"; incomplete occlusion of a vein is 'flattening'."flattening")
• Compression -compression: any cross-sectional narrowing of an airway (only).
• Synchronoussynchronous and Metachronousmetachronous tumours should be staged separately