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The role of computed tomography in the management of children with advanced neuroblastoma.

Computed tomography (CT) was found to be a valuable method of assessing the extent of local disease in 36 patients with advanced neuroblastoma. Precise predictions on the operability of tumours can be made so that the timing of primary or "second look" surgery may be optimised. However, intraspinal extension of tumour is not detected on CT examinations without intrathecal contrast medium and plain radiographs are not a reliable guide to the presence of intraspinal disease; the examination should include intrathecal contrast medium (CT myelography) when patients undergo pre-operative staging by CT. The majority of neuroblastomas appear calcified on CT. During chemotherapy the most common change in tumour morphology is decrease in size and increase in calcification. There is however no correlation between tumour size or behaviour during chemotherapy and eventual survival but an increase in size during or after treatment is a serious prognostic sign.