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 .

Clinical presentation

  • proptosis
  • periorbital ecchymosis ("racoon eyes")
  • palpable calvarial masses

Radiographic features

  • 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
Nuclear medicine
  • 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

Differential diagnosis

Imaging differential considerations include: