Image-defined risk factors are imaging features seen at the time of neuroblastoma diagnosis that confer a poorer prognosis. The International Neuroblastoma Risk Group (INRG) suggested an update (2009) to the neuroblastoma staging with a list of features that, if present, upstages a patient with local disease from L1 to L2.
Crossing/extending
from one compartment to another (e.g. chest to neck, abdomen to chest, abdomen to pelvis)
through sciatic notch/foramen
Encasing vessels
superior mesenteric artery (including branches at the mesenteric root)
iliac artery or vein
Compressing
Encasing nerves
brachial plexus roots
Invading and infiltrating
to skull base
-
into spinal canal - defined as;
>1/3 of canal involved on an axial section
perimedullary leptomeningeal space not visible
signal change in the adjacent spinal cord
costovertebral junction from T9-T12
renal pedicle or kidney
duodenopancreatic block
Practical points
encasement: in contact with >50% (artery or vein) or completely occluding a vein (NB <50% is "contact"; incomplete occlusion of a vein is "flattening")
compression: any cross-sectional narrowing of an airway
synchronous and metachronous tumours should be staged separately
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