Abstract
BackgroundMR imaging of neuroblastic tumors is widely used for assessing the effect of chemotherapy on tumor size. However, there are some concerns that MRI might falsely estimate lesion diameters due to calcification and fibrosis. Therefore, the aim of our study was to compare neuroblastic tumor size based on MRI measurements to histopathology measurements of the resected specimens as standard of reference.MethodsInclusion criteria were diagnosis of a neuroblastic tumor, MR imaging within 100 days to surgery and gross total resection without fragmentation of the tumor between 2008 and 2019. Lesion diameters were measured by two radiologists according to RECIST 1.1 in axial plane in T2w turbo spin echo (TSE), diffusion-weighted imaging (DWI), and in T1w pre- and postcontrast sequences. Furthermore, the largest lesion size in three-dimensions was noted. The largest diameter of histopathology measurements of each specimen was used for comparison with MRI.ResultsThirty-seven patients (mean age: 5 ± 4 years) with 38 lesions (neuroblastoma: n = 17; ganglioneuroblastoma: n = 11; ganglioneuroma: n = 10) were included in this retrospective study. There was excellent intra-class correlation coefficient between both readers for all sequences (> 0.9) Tumor dimensions of reader 1 based on axial MRI measurements were significantly smaller with the following median differences (cm): T1w precontrast − 1.4 (interquartile range (IQR): 1.8), T1w postcontrast − 1.0 (IQR: 1.9), T2w TSE: -1.0 (IQR: 1.6), and DWI -1.3 (IQR: 2.2) (p < 0.001 for all sequences). However, the evaluation revealed no significant differences between the three-dimensional measurements and histopathology measurements of the resected specimens regardless of the applied MRI sequence.ConclusionsAxial MRI based lesion size measurements are significantly smaller than histopathological measurements. However, there was no significant difference between three-dimensional measurements and histopathology measurements of the resected specimens. T2w TSE and T1w postcontrast images provided the lowest deviation and might consequently be preferred for measurements.
Highlights
MR imaging of neuroblastic tumors is widely used for assessing the effect of chemotherapy on tumor size
This study demonstrated that there is a significant difference between all axial magnetic resonance imaging (MRI) measurements and measurements of the resected specimens in neuroblastic tumors independently of the applied sequence
diffusion-weighted imaging (DWI) provided in our study after Bland-Altman assessment larger differences, without significant difference compared to the resected specimens using the 3D approach
Summary
MR imaging of neuroblastic tumors is widely used for assessing the effect of chemotherapy on tumor size. The evaluation of response to chemotherapy prior to surgical resection is of paramount importance [11]. According to the INRGSS, the tumor size should be determined via a three-dimensional (3D) measurement of the tumor with CT or MRI [5]. This contradicts the very common Response Evaluation Criteria In Solid Tumors (RECIST) which state that only the largest diameter should be taken into account [12, 13]. For residual tumor assessment the discrepancy between the resected specimens and preoperative measurements is of utmost importance. In follow-up examinations of residual tumor the correctness of lesion size measurements is indispensable for the process of local disease progression
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