PMC4891622_01
Initial study. 1A. Coronal STIR (TR 2700, TE 73) MR image shows a focal lesion in the distal left femoral diametaphysis showing minimally increased signal, consistent with a treated neuroblastoma metastasis. 1B. Coronal T1 (TR 600, TE 8) MR image better depicts the intermediate-low signal treated lesion, as well as an additional, barely conspicuous lesion in the distal right femoral metaphysis. [Powerpoint Slide]
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The pre-treatment MR imaging of the lower extremities demonstrated two known, treated metastatic lesions located in the distal aspects of the left femoral diametaphysis and right femoral metaphysis (Fig. 1).
Coronal STIR (TR 3900, TE 44) MR image demonstrates the known, treated femoral lesions as well as new abnormal patchy hyperintense signal within the distal femora and proximal tibiae, especially along the physes.. 2B. Coronal T1 (TR 550, TE 11) MR image shows corresponding patchy decreased marrow signal.. 2C. Coronal T1 with fat saturation (TR 717, TE 11) post contrast MR image demonstrates corresponding mild patchy marrow enhancement. [Powerpoint Slide]
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Three weeks following the initiation of chemotherapy, MRI of the lower extremities was repeated (Fig. 2).
Coronal STIR (TR 4500, TE 40) MR image shows decreased patchy abnormal marrow signal in the distal femora and proximal tibiae.. B. Coronal T1 (TR 550, 8TE) demonstrates corresponding interval decrease in patchy low marrow signal.. C. Coronal T1 with fat saturation (TR 145, TE 3) post contrast reveals the corresponding, very mild enhancement. [Powerpoint Slide]
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MRI was repeated three weeks later, or six weeks post initiation of chemotherapy (Fig. 3).
I131-mIBG scan shows no abnormal radiotracer uptake to suggest metastatic disease. [Powerpoint Slide]
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One week later, I131-MIBG scan showed no evidence of recurrent or active metastatic disease (Fig. 4).