Neuroblastoma Metastases

This is a coronal post-gadolinium T1-weighted MPRAGE* MRI of a 2 year-old female with known neuroblastoma. There are orbital and skull vault metastases, with associated enhancing soft-tissue masses. The skull lesions are extradural masses which deform the underlying brain. The right orbital lesion forms a superior extraconal mass, depressing the right globe.
Neuroblastoma not uncommonly metastasises to the skull. The metastases are generally osteolytic, enlarge the bone, strip the dura from it, and produce intracranial mass effect. Other skull metastases include osteogenic sarcoma (usually osteoblastic lesions); leukaemia; Wilm’s tumour; Ewing’s tumour; and hepatoblastoma.
*MPRAGE is an MRI acronym which stands for Magnetisation Prepared RApid Gradient Echo. It is a magnetisation prepared (inversion pulse applied prior to acquisition) spoiled gradient echo sequence. MPRAGE is rapidly acquired, high signal intensity and high contrast. Images are predominantly T1-weighted, and 3D acquisitions are possible.
Reference: Silverman FN, Kuhn JP. Essentials of Caffey’s Pediatric X-Ray Diagnosis. Year Book Medical Publishers 1990.
Credit: Dr Laughlin Dawes
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