Lionberg Alex,  Ong Seng

Final Pr. ID: Poster #: EDU-096

Neuroblastoma is recognized as having a broad spectrum of clinical behavior in children diagnosed with the disease. Some tumors exhibit aggressive characteristics and portend a poor prognosis, while others that appear aggressive spontaneously regress. Accurately identifying high risk neuroblastoma is important in determining which patients will benefit most from intense chemotherapy, which unfortunately carries a risk of significant adverse effects later in life. Historically this has been difficult, as the classification schemes vary in different parts of the world, limiting the ability to pool data and improve prognostication. In recent years, efforts among experts around the globe have led to a consensus on the most evidenced based approach to staging. The aim of this educational exhibit is to describe the new standardized language for radiology reports, which will contribute to accurate staging and improve treatment for patients with neuroblastoma. Additionally, key imaging features highlighting image defined risk factors will be presented. Read More

Authors:  Lionberg Alex , Ong Seng

Keywords:  Neuroblastoma, Oncology, Tumor Staging

Lee Samantha,  Cajigas-loyola Stephanie,  Acord Michael

Final Pr. ID: Poster #: EDU-031

Pediatric primary liver tumors, including hepatoblastoma and hepatocellular carcinoma (HCC), are staged according to the PRETEXT system (PRE-Treatment EXTent of Tumor). Although primary hepatic tumors are rare in the pediatric population, hepatoblastoma is increasing in prevalence due to its association with prematurity and the prolonged survival of this patient population. Therefore, it is prudent for radiologists to refamiliarize themselves with these malignancies and how to accurately describe their imaging appearance using descriptors defined by PRETEXT.

Various imaging modalities offer a role in the evaluation of primary hepatic tumors, including ultrasound (US), magnetic resonance (MR), and computed tomography (CT). Contrast enhanced ultrasound (CEUS) is not currently a primary modality but has potential to evaluate vascular involvement and satellite lesions. PRETEXT is the standard to describe a tumor’s imaging features on CT or MR; MR is preferred due to improved soft tissue detail, and emphasis is placed on use of a hepatobiliary contrast agent.

For PRETEXT staging, the liver is divided into four sections: right posterior, right anterior, left medial, and left lateral. Depending on the number of continuous, uninvolved sections, patients are assigned a group ranging from I-IV. Tumors are often large at presentation, and determination of anatomic boundaries can be challenging for the radiologist. Other special circumstances discussed include variant hepatic venous anatomy and pedunculated tumors. PRETEXT also considers “annotation factors”, such as vascular involvement, tumor rupture, and metastases, among others.

In combination with clinical factors, such as the patient's age and alpha-fetoprotein (AFP) level, PRETEXT is also used to stratify patient risk and ultimately influence patient management. If the tumor is not resectable upfront, percutaneous biopsy is recommended to confirm the diagnosis. First line therapy includes surgical resection and systemic chemotherapy. In cases not amenable to this treatment, palliative options offered by pediatric interventional radiology include transarterial chemoembolization (TACE) and percutaneous ablation.

The goal of this educational exhibit is to provide a case-based illustration of PRETEXT staging and annotations factors for the pediatric radiologist. Read More

Authors:  Lee Samantha , Cajigas-loyola Stephanie , Acord Michael

Keywords:  PRETEXT, Primary Hepatic Tumor, Staging