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Fig. 31. Neuroblastoma. 13-year-old girl with metastatic stage IV neuroblastoma and new-onset bilateral leg paresthesias and weakness. Sagittal fat-suppressed post-contrast T1 MRI shows epidural extension of an enhancing lesion ( arrow ).

( Fig. 29 ). Invasion of the central skull base and extension into the adjacent paraphar yngeal space, the pterygopalatine fossa, and the masticator space are not uncommon features of pediatric nasopharyngeal carcinoma and are readily depicted on MRI. Neuroblastoma On MRI, neuroblastoma is typically isointense to hypointense to muscle on T1 weighted images and hyperintense on T2 weighted images, and it demonstrates enhancement (see Fig. 30 ). 39 Heterogneous signal characteristics can be attributable to necrosis and hemorrhage. MRI is superior to CT for staging, particularly with respect to identifying bone marrow infiltration and intraspinal extension of tumor ( Fig. 31 ). 40 Additionally, MRI is better than CT for post-treatment follow-up of midline or paraspinal neuroblastomas. 40 Ultimately, the evaluation of patients with neuroblas toma may require a multimodality approach, including metaiodobenzylguanidine (MIBG) nuclear scans. 1. Friedman ER, John SD. Imaging of pediatric neck masses. Radiol Clin North Am 2011;49(4):617–32, v. 2. American College of Radiology. ACR appropriateness criteria: neck mass/ adenopathy. Available at: www.acr.org/ w /media/ACR/Documents/AppCriteria/ Diagnostic/NeckMassAdenopathy.pdf. Accessed January 10, 2014. 3. Gupta P, Maddalozzo J. Preoperative sonography in presumed thyroglossal duct cysts. Arch Otolaryngol Head Neck Surg 2001;127(2):200–2. 4. Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol 2005;184(5):1691–9. 5. Lloyd C, McHugh K. The role of radiology in head and neck tumours in children. Cancer Imaging 2010;10:49–61. REFERENCES

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