Craniocerebral neuroblastoma metastases usually involve the calvaria, orbits, skull base and the dura.
Please refer to the article neuroblastoma for a general discussion on this entity.
In children, neuroblastoma is the most common cause of orbital metastases 4.
- periorbital ecchymosis ("racoon eyes")
- palpable calvarial masses
- spiculated periorbital bone mass, typically involving the roof or lateral wall/sphenoid wings
- "hair on end" spiculated periostitis of orbits and skull usually associated with bone destruction
- sutural separation: non-uniform sutural separation with indistinct suture margins
- cranial metastasis nearly always extradural (may mimic epidural or subdural hematoma)
- T1: hypointense to muscles
- T2: heterogeneous usually hyperintense to muscles
- T1 C+ (Gd): vigorously enhances, may be heterogeneous
- MRV: may narrow or invade adjacent dural sinuses
- MIBG (meta-iodo benzyl guanidine): avid uptake by neural crest tumors
- TC-99-m-MDP: shows increased uptake due to the calcium metabolism of the tumor
- PET: shows high sensitivity and specificity for recurrent tumors
Imaging differential considerations include:
- 1. Osborn AG, Salzman KL, Barkovich AJ. Diagnostic Imaging. Lippincott Williams & Wilkins. (2009) ISBN:1931884722. Read it at Google Books - Find it at Amazon
- 2. D'Ambrosio N, Lyo JK, Young RJ et-al. Imaging of metastatic CNS neuroblastoma. AJR Am J Roentgenol. 2010;194 (5): 1223-9. doi:10.2214/AJR.09.3203 - Pubmed citation
- 3. Chirathivat S, Post MJ. CT demonstration of dural metastases in neuroblastoma. J Comput Assist Tomogr. 1980;4 (3): 316-9. Pubmed citation
- 4. Chung EM, Murphey MD, Specht CS, Cube R, Smirniotopoulos JG. From the Archives of the AFIP. Pediatric orbit tumors and tumorlike lesions: osseous lesions of the orbit. (2008) Radiographics : a review publication of the Radiological Society of North America, Inc. 28 (4): 1193-214. doi:10.1148/rg.284085013 - Pubmed