Anterior projection from an MIBG scan shows diffuse skeletal | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Anterior projection from an MIBG scan shows diffuse skeletal metastases and a large intra-abdominal neuroblastoma. The bone metastases are most pronounced in the skull. Neuroblastoma is the most common extracranial solid malignancy of childhood. It most commonly metastasizes as two bones. Other entities that can cause diffuse thickening of the calvarium include thalassemia, sickle cell disease, and certain medications. #FridayQuizDay #FridayQuiz

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Axial contrast-enhanced CT of the abdomen (image 1) shows the large retroperitoneal mass (arrow) uplifting the abdominal aorta (arrowhead). There are diffuse bone metastases with an abnormal appearance of the vertebral bodies on the sagittal CT of the spine (image 2). MIBG scan (image 3) shows bone metastases involving the calvarium, humeri, ribs, spine, pelvis, and femurs. The imaging findings are consistent with neuroblastoma. Neuroblastoma most commonly arises from the adrenal glands. It displaces and uplifts vessels. Neuroblastoma most commonly metastasizes to bone, bone marrow, and the liver.](https://app.figure1.com/case-detail/04d31e33-5f02-4ca8-9af1-90eea2e64162)

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AP (image 1) and lateral (image 2) radiograph if the distal femur shows an aggressive bone tumor with periosteal new bone formation (arrows), a Codman triangle (arrow on lateral view), and a permeative appearance of the bone. This patient was later diagnosed with neuroblastoma as seen on the MIBG scan (image 3). Skeletal uptake (double-sided arrow) is never normal on MIBG scans and is indicative of metastatic disease. Liver metastases are also present as the liver is enlarged and has diffuse uptake of the radiopharmaceutical. Neuroblastoma most commonly metastasizes to bone, bone marrow, and the liver. #MSKMonday](https://app.figure1.com/case-detail/20036d9b-3b53-4483-817e-b91d45ff8a98)

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