Eliminating Unenhanced CT When Evaluating Abdominal Neoplasms in Children

Silva, Eduardo Just da Costa e; Silva, Gisélia Alves Pontes da

doi:10.2214/ajr.07.2154

Cited by 29 publications

(11 citation statements)

References 21 publications

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“…Precontrast CT scans of the abdomen were available in our cohort in only 12 of 136 subjects, which limits our ability to detect intratumoral hemorrhage. However, routine performance of multiphase and precontrast images is not recommended in pediatric oncology patients to limit radiation exposure (18). In the study by Brisse et al (7), all patients with intratumoral hemorrhage at imaging were classified as having retroperitoneal rupture.…”

Section: Discussionmentioning

confidence: 99%

Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

Khanna¹,

Naranjo²,

Hoffer³

et al. 2013

Radiology

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Purpose:To retrospectively determine the diagnostic performance of computed tomography (CT) in identifying the presence or absence of preoperative Wilms tumor rupture. Materials and Methods:The cohort was derived from the AREN03B2 study of the Children's Oncology Group. The study was approved by the institutional review board and was compliant with HIPAA. Written informed consent was obtained before enrollment. The diagnosis of Wilms tumor rupture was established by central review of notes from surgery and/or pathologic examination. Seventy Wilms tumor cases with rupture were matched to 70 Wilms tumor controls without rupture according to age and tumor weight (within 6 months and 50 g, respectively). CT scans were independently reviewed by two radiologists, and the following CT findings were assessed: poorly circumscribed mass, perinephric fat stranding, peritumoral fat planes obscured, retroperitoneal fluid (subcapsular vs extracapsular), ascites beyond the cul-de-sac, peritoneal implants, ipsilateral pleural effusion, and intratumoral hemorrhage. All fluids were classified as hemorrhagic or nonhemorrhagic by using a cutoff of 30 HU. The relationship between CT findings and rupture was assessed with logistic regression models. Results:The sensitivity and specificity for detecting Wilms tumor rupture were 54% (36 of 67 cases) and 88% (61 of 69 cases), respectively, for reviewer 1 and 70% (47 of 67 cases) and 88% (61 of 69 cases), respectively, for reviewer 2. Interobserver agreement was substantial (ĸ = 0.76). All imaging signs tested, except peritoneal implants, intratumoral hemorrhage, and subcapsular fluid, showed a significant association with rupture (P  .02). The attenuation of ascitic fluid did not have a significant correlation with rupture (P = .9990). Ascites beyond the cul-de-sac was the single best indicator of rupture for both reviewers, followed by perinephric fat stranding and retroperitoneal fluid for reviewers 1 and 2, respectively (P , .01). Conclusion:CT has moderate specificity but relatively low sensitivity in the detection of preoperative Wilms tumor rupture. Ascites beyond the cul-de-sac, irrespective of attenuation, is most predictive of rupture.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Discussionmentioning

confidence: 99%

Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

Khanna¹,

Naranjo²,

Hoffer³

et al. 2013

Radiology

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“…The use of precontrast CT scans hardly ever results in clinically relevant extra information and usually should be abandoned [53]. If further characterisation of a lesion by multiple pre- and post-CM phases is indicated, MRI is currently the preferred imaging modality of choice.…”

Section: Optimisation Of Paediatric Ctmentioning

confidence: 99%

Multidetector CT in children: current concepts and dose reduction strategies

2010

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The recent technical development of multidetector CT (MDCT) has contributed to a substantial increase in its diagnostic applications and accuracy in children. A major drawback of MDCT is the use of ionising radiation with the risk of inducing secondary cancer. Therefore, justification and optimisation of paediatric MDCT is of great importance in order to minimise these risks (“as low as reasonably achievable” principle). This review will focus on all technical and non-technical aspects relevant for paediatric MDCT optimisation and includes guidelines for radiation dose level-based CT protocols.

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“…Apart from the radiation involved in CT, sedation and general anesthesia are important factors in planning and performing these studies [24,25]. CT Technical differences in CT imaging for liver tumors in children as compared with adults focus on reduction of the radiation burden, primarily by eliminating unenhanced CT and by using multiphase contrast studies only in few selected cases [26][27][28][29]. The CT parameters used in our institution include: slice thickness ranges from 2.5 to 5 mm, pitch 1.0-1.5, 80-120 kVp and 120-140 mAs [30][31][32].…”

Section: Ct and Mri In Pediatric Liver Tumors: Technical Aspectsmentioning

confidence: 99%

Pediatric liver tumors – a pictorial review

et al. 2008

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Hepatic masses constitute about 5-6% of all intra-abdominal masses in children. The majority of liver tumors in children are malignant; these malignant liver tumors constitute the third most common intra-abdominal malignancy in the pediatric age group after Wilms' tumor and neuroblastoma. Only about one third of the liver tumors are benign. A differential diagnosis of liver tumors in children can be obtained based on the age of the child, clinical information (in particular AFP) and imaging characteristics. The purpose of this review is to report typical clinical and imaging characteristics of benign and malignant primary liver tumors in children.

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Eliminating Unenhanced CT When Evaluating Abdominal Neoplasms in Children

Abstract: CT protocols without the unenhanced phase are a viable alternative for evaluating abdominal neoplasms in children and adolescents.

Cited by 29 publications

References 21 publications

Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

Multidetector CT in children: current concepts and dose reduction strategies

Pediatric liver tumors – a pictorial review

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