title: Imaging findings of patients with metastatic neuroblastoma to the brain.
abstract: OBJECTIVE
  Metastatic involvement of brain is rare in neuroblastoma (NB). We retrospectively evaluated conventional and advanced imaging and clinical findings of seven patients with secondary intra-axial brain NB metastases.
  
  
  METHODS
  Magnetic resonance imaging and computed tomography examinations of patients with metastatic brain NB were reviewed. Recent iodine-123 metaiodobenzylguanidine ((123)I-MIBG) scans were also reviewed. A medical record review was performed for relevant clinical, laboratory, histopathologic, and genetic data.
  
  
  RESULTS
  Mean age at the time of primary tumor diagnosis was 35 months, and all were considered high-risk NB at diagnosis. Mean time interval between diagnosis and brain involvement was 23.2 months. Extensive prior extra-central nervous system (CNS) disease was present in all patients, but concomitant extra-CNS disease at the time of brain involvement was absent in three (43%) patients. Various forms of disease, including intraparenchymal, intraventricular, and leptomeningeal lesions were detected. Most intraparenchymal lesions were supratentorial and hemorrhagic; however, hemorrhage was absent in multiple leptomeningeal nodules in one patient. Contrast enhancement of lesions was present on all contrast-enhanced studies. Restricted diffusion of lesions was present in two patients. Arterial spin labeling (ASL) perfusion in two patients also revealed increased cerebral blood flow. Recent (123)I-MIBG scans were available in four patients and showed lesions in two patients with larger metastases but failed to demonstrate lesions in another two patients with smaller lesions.
  
  
  CONCLUSIONS
  Brain metastases of NB are often supratentorial and hemorrhagic and demonstrate contrast enhancement. Diffusion-weighted imaging can show restricted diffusion. ASL images may reveal increased perfusion. MIBG scans may not show smaller brain metastases.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA 19104. Electronic address: seyedali.nabavizadeh@uphs.upenn.edu.
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Nabavizadeh
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA 19104.
authors.forename: Tamara
authors.initials: T
authors.lastname: Feygin
authors.affiliation: Department of Pathology, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA 19104.
authors.forename: Brian N
authors.initials: BN
authors.lastname: Harding
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA 19104.
authors.forename: Larissa T
authors.initials: LT
authors.lastname: Bilaniuk
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA 19104.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St and Civic Center Blvd, Philadelphia, PA 19104.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009447:Neuroblastoma / Q000175:diagnosis* / Q000556:secondary*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Neuroblastoma; brain; metastasis; pediatric