Fig. 7.
Hemorrhage in MYCN-amplified childhood neuroblastoma MRI and initial experience with SW-MRI in the neuroblastoma clinic. (A-C) show abdominal axial fat-suppressed STIR T2-weighted-MRI images, fat-suppressed SPAIR T1-weighted MRI images, before and after administration of gadolinium (Gd)-based contrast agent, and diffusion-weighted MRI-derived apparent diffusion coefficient (ADC) maps of children with neuroblastoma (NB) at the time of diagnosis. (A) MYCN-amplified high-risk neuroblastoma in a 10-month old boy, (B) a 2-year old boy, (C) a 8-month-old boy, (D) Comparison between a ganglioneuroblastoma (GNB) in a 4-year-old female patient and ganglioneuroblastoma nodular (GNB) in a 5-year-old male patient. Note the presence of the neuroblastic nodule in the GNBn easily identified on ADC maps (arrow head) (E) Proportion of patients with MYCN-amplified neuroblastoma (n=19) presenting with a MRI phenotype suggestive of the presence or absence of a hemorrhagic phenotype, based on the well-established knowledge of the appearance of ageing blood in hematoma on conventional MRI (25) as illustrated in (F). (G) show abdominal T2-weighted and T1-weighted images (not fat-suppressed), ADC maps, intrinsic susceptibility MRI-derived transverse relaxation R2* map of tumors, and post Gd contrast-enhanced T1-weighted MRI images in children with refractory/relapsing neuroblastoma. (Patient 1: 7-year old male, Patient 2: 5-year old male, Patient 3: 6-year old female). (H) Tumor median R2* values for each individual tumor shown in (G) (±SD). Note that R2* values increased monotonically and approximatively linearly with magnetic field strength-dependent and as such clinical R2* value at 1.5T are estimated to be four times lower that if they were measured at 7T (47).