Neuroblastoma (craniocerebral metastases)
Craniocerebral neuroblastoma metastases usually involve the calvaria, orbits, skull base and the dura.
Please refer to the article neuroblastoma for a general discussion on this entity.
In children, neuroblastoma is the most common cause of orbital metastases .
- periorbital ecchymosis ("racoon eyes")
- palpable calvarial masses
- spiculated periorbital bone mass, typically involving the roof or lateral wall/sphenoid wings
- "hair on end" spiculated periostitis of orbits and skull usually associated with bone destruction
- sutural separation: non-uniform sutural separation with indistinct suture margins
- cranial metastasis nearly always extradural (may mimic epidural or subdural hematoma)
- T1: hypointense to muscles
- T2: heterogeneous usually hyperintense to muscles
- T1 C+ (Gd): vigorously enhances, may be heterogeneous
- MRV: may narrow or invade adjacent dural sinuses
- MIBG (meta-iodo benzyl guanidine): avid uptake by neural crest tumors
- TC-99-m-MDP: shows increased uptake due to the calcium metabolism of the tumor
- PET: shows high sensitivity and specificity for recurrent tumors
Imaging differential considerations include: