Diagnosis, Management, and Treatment of Neuroblastoma

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 1.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 1.50
Endocrine and Oncology Procedures: 1.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Abdominal Section: 0.25
Thoracic Section: 0.25
Musculoskeletal and Endocrine Sections: 0.25
Neurological, Vascular, and Lymphatic Sections: 0.75

Radiation Therapy: 1.50
Patient Care: 0.75
Patient and Medical Record Management: 0.75
Procedures: 0.75
Treatment Sites and Tumors: 0.75

Outline

1. Introduction
2. Epidemiology
3. Pathogenesis
4. Diagnosis
5. Imaging of Neuroblastoma
   1. Evaluation with US
   2. CT and MR Imaging
   3. Nuclear Medicine
6. Staging
7. Treatment
8. Conclusion

Objectives

Upon completion of this course, students will:

1. know the locations from which neuroblastomas arise
2. be familiar with the timeframe in which neuroblastoma is diagnosed
3. understand the possible clinical symptoms of neuroblastoma
4. identify the common sites of neuroblastoma metastases
5. be familiar with various conditions that can present as a result of a patient’s neuroblastoma
6. recognize what is associated with MYCN gene amplification in patients with neuroblastoma
7. understand how a neuroblastoma’s DNA index affects the prognosis for patients younger than 18 months of age
8. know how neuroblastomas are linked to genetic heritage
9. know the basis for neuroblastoma diagnoses
10. identify what is necessary to fully evaluate the extent of neuroblastoma
11. know why malignant small round cell tumors are sometimes histologically referred to as “blue”
12. be familiar with the INPC prognostic classification system for neuroblastoma
13. identify what can provide chemical evidence of neuroblastoma when detected in serum and urine levels in elevated quantities
14. know the first imaging examination performed when an abdominal mass is suspected in a child
15. understand how neuroblastomas affect the surrounding vasculature
16. be familiar with some facts and study findings about congenital neuroblastoma
17. identify the advantages of CT and MR imaging in the detection and evaluation of neuroblastoma
18. know why MR imaging demonstrates a better sensitivity for neuroblastoma evaluation than CT
19. be familiar with the strengths, advantages, and isotopes used in MIBG scintigraphy
20. understand how the modified Curie scoring method is used in the interpretation of MIBG avidity for patients with high-risk neuroblastoma
21. be familiar with the advantages of MIBG scintigraphy over ¹¹¹In pentetreotide
22. know when FDG PET/CT can be a useful diagnostic tool for imaging patients with neuroblastoma
23. be familiar with the PET imaging agents and advantages for neuroblastoma imaging
24. be familiar with the INRGSS’s image-defined risk factors
25. understand the terms used to describe a primary tumor in the INRGSS and which constitutes an IDRF
26. recognize the modifications that the INRGSS has made to older INSS for neuroblastoma staging
27. be familiar with the descriptions of the various INRGSS stages
28. be familiar with the Children’s Oncology Group’s risk stratification system for neuroblastoma
29. understand the situations in which surgery, chemotherapy, and radiation therapy should be considered for low, intermediate-, and high-risk neuroblastoma patients
30. know the benefits and adverse effects of therapeutic ¹³¹I MIBG