Comparison between whole-body magnetic resonance imaging and whole-body metaiodobenzylguanidine scintigraphy in the evaluation of primary tumor and metastases in neuroblastoma.

BACKGROUND: Whole-body metaiodobenzylguanidine (131 I-MIBG) scintigraphy is the gold standard method to detect neuroblastoma; however, it depends on radioactive material and is expensive. In contrast, whole-body magnetic resonance imaging (WB-MRI) is affordable in developing countries and has been shown to be effective in the evaluation of solid tumors. This study aimed to compare the sensitivity and specificity of WB-MRI with MIBG in the detection of primary tumors and neuroblastoma metastases. PROCEDURE: This retrospective study enrolled patients with neuroblastoma between 2013 and 2020. All patients underwent WB-MRI and MIBG at intervals of up to 15 days. The results were marked in a table that discriminated anatomical regions for each patient. Two experts evaluated, independently and in anonymity, the WB-MRI images, and two others evaluated MIBG. The results were compared in terms of sensitivity and specificity, for each patient, considering MIBG as the gold standard. This study was approved by the UNIFESP Ethics Committee. RESULTS: Thirty patients with neuroblastoma were enrolled in this study. The age ranged from 1 to 15 years, with a mean of 5.7 years. The interval between exams (WB-MRI and MIBG) ranged from 1 to 13 days, with an average of 6.67 days. Compared to MIBG, WB-MRI presented a sensitivity and specificity greater than or equal to 90% for the detection of primary neuroblastoma in bones and lymph nodes. When we consider the patient without individualizing the anatomical regions, WB-MRI presented sensitivity of 90% and specificity of 73.33%. CONCLUSION: In conclusion, WB-MRI is a sensitive and specific method to detect neuroblastoma in bone and lymph nodes and highly sensible to primary tumor diagnosis, suggesting that this test is a viable alternative in places where MIBG is difficult to access. Studies with a larger number of cases are necessary for definitive conclusions.

Surgery in Bilateral Wilms Tumor-A Single-Center Experience.

The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute-GRAACC-Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety.

Diagnostic Errors in Wilms' Tumors: Learning From Our Mistakes.

Aim: This study aimed to analyze clinical characteristics and image findings in patients initially diagnosed with renal masses and treated on the Société Internationale d'Oncologie Pédiatrique (SIOP) 2001 protocol for Wilms tumor (WT) that eventually were diagnosed with different pathologies. Methods: We reviewed the preoperative symptoms, laboratory tests, and images of patients who were initially treated for WT and proved to have other diagnoses. Data from these patients were compared to those of the last 10 patients with WT and the last 10 patients with neuroblastoma (NBL) treated at a single institution. Results: From June 2001 to December 2020, we treated 299 patients with NBL and 194 with WT. Five patients treated with preoperative chemotherapy for WT were postoperatively diagnosed with NBL (one patient had bilateral renal masses and one with multifocal xanthogranulomatous pyelonephritis). Three underwent nephrectomy, two biopsies only, and one adrenalectomy due to intraoperative characteristics. Regarding clinical presentation, abdominal mass or swelling was very suggestive of WT (p = 0.011); pain, although very prevalent in the study group (67%), was not statistically significant, as well as intratumoral calcifications on computed tomography (CT) (67%). Urinary catecholamines were elevated in all patients mistreated for WT with the exception of the patient with pyelonephritis in which it was not collected. Conclusion: Some pathologies can be misdiagnosed as WT, especially when they present unspecified symptoms and dubious images. Diagnostic accuracy was 98.1%, which highlights the quality of the multidisciplinary team. Abdominal mass or swelling is highly suggestive of WT, especially in the absence of intratumoral calcifications on CT. If possible, urinary catecholamines should be collected at presentation as they help in the differential diagnosis of NBL.

The Role of Whole-Body MRI in Pediatric Musculoskeletal Oncology: Current Concepts and Clinical Applications.

Whole-body magnetic resonance imaging (WB-MRI) has gained importance in the field of musculoskeletal oncology over the last decades, consisting in a one-stop imaging method that allows a wide coverage assessment of both bone and soft tissue involvement. WB-MRI is valuable for diagnosis, staging, and follow-up in many oncologic diseases and is especially advantageous for the pediatric population since it avoids redundant examinations and exposure to ionizing radiation in patients who often undergo long-term surveillance. Its clinical application has been studied in many pediatric neoplasms, such as cancer predisposition syndromes, Langerhans cell histiocytosis, lymphoma, sarcomas, and neuroblastoma. The addition of diffusion-weighted sequences allows functional evaluation of neoplastic lesions, which is helpful in the assessment of viable tumor and response to treatment after neoadjuvant or adjuvant therapy. WB-MRI is an excellent alternative to fluorodeoxyglucose-positron emission tomography/computed tomography in oncologic children, with comparable accuracy and the convenience of being radiation-free, fast to perform, and available at a similar cost. The development of new techniques and protocols makes WB-MRI increasingly faster, safer, and more accessible, and it is important for referring physicians and radiologists to recognize the role of this imaging method in pediatric oncology. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.

MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role?

INTRODUCTION: Mammography remains the standard imaging modality for the identification and characterization of breast calcifications. However, its low specificity results in high biopsy rates in cases of suspicious calcifications. OBJECTIVES: To evaluate the diagnostic performance of MRI as an additional tool in the assessment of suspicious mammographic calcifications and to identify the enhancement patterns most related to malignancy. METHODS: An observational, prospective, cross-sectional, bi-centre study was conducted including consecutive patients with suspicious calcification groups on mammography (BI-RADS® 4 and 5). Anatomopathological results obtained from biopsies were considered the reference standard, and the patients were followed up for at least two years. MRI examinations were interpreted by two radiologists in consensus. The chi-square test was used to evaluate the correlation between MRI features and histological results. The overall diagnostic performance of MRI for malignancy was calculated. RESULTS: 162 female patients were included (mean age, 53 years; range 34-82 years), with 163 mammographic lesions, of which 77 (47.2%) were benign, 64 (39.3%) malignant, and 22 (13.5%) precursor lesions on histopathology. Malignant lesions demonstrated a significantly higher presence of enhancement (56/64; 87.5%) than benign lesions (17/77; 22.1%) (p < 0.001). Non-mass enhancement (NME) was the morphology most related to malignant lesions (38/56; 67.9%). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI for malignancy were 81.5%, 87.5%, 77.8%, 71.8%, and 90.5%, respectively. CONCLUSION: MRI performed as an adjunct tool allows to increase imaging specificity for malignancy in suspicious calcifications, which may contribute to reduce the need for biopsy.

Ultrasound as a Valuable Imaging Modality in Sclerosing Lymphocytic Lobulitis: Imaging Features Based on a Retrospective Cohort Analysis of 51 Cases.

PURPOSE: Sclerosing lymphocytic lobulitis (SLL) is a rare benign breast condition usually associated with diabetes mellitus and whose imaging features have been assessed in few studies, limiting the adoption of diagnostic guidelines. We aimed to identify the main morphological features associated with SLL on imaging examinations (mainly ultrasound and mammography) and to retrospectively evaluate the role that each method played in the diagnostic workup (detection and indication for biopsy). METHODS: A retrospective study was conducted in a high-volume single center, encompassing 51 consecutive patients (100% female; 26-78 y; 43.7 ± 15.5 y) with histopathologically proven SLL (59 lesions; 0.5-6.1 cm). RESULTS: Most lesions (31/59; 53%) were found in asymptomatic individuals. Ultrasound detected 91.1% (51 out of 56 lesions assessed by this modality), of which 94.1% were non-circumscribed masses (BI-RADS® 4). Mammography detected 41.6% (15 out of 36 lesions assessed by this modality), with a predominance (80%) of non-calcified ones (masses, asymmetries and distortion). Two-year follow-up was achieved in 29 lesions (49%), showing complete remission (45%) or stability (41%) in most cases. CONCLUSIONS: Most lesions in this retrospective sample have been detected by means of ultrasound and had their need for biopsy indicated by this modality. Female diabetic patients younger than 40 years presenting with a palpable lesion and a non-circumscribed mass on ultrasound could be submitted to core biopsy; histopathologic findings suggestive of SLL should be considered concordant in this scenario, with subsequent conservative treatment.

Management of Pediatric Tumors With Vascular Extension.

Background: Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible. Objective: To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol. Method: Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for cardiac bypass that are adequate for each situation. Image studies are important to guide the surgical strategy. Depending on the quality of image available, computerized tomography (CT) or magnetic resonance imaging (MRI) can be enough to give the information needed for surgical decisions. Ultrasonography (US) with Doppler is helpful to confirm diagnosis and describes factors to guide the adequate surgical strategy, like the upper level extension and presence or absence of blood flow around the thrombus. Neoadjuvant chemotherapy is indicated in most cases, in order to reduce the upper level of extension (and avoid the need for cardiac bypass) and to lower the risk of embolization. The approach is based on the upper level of the thrombus and can include cavotomy or cavectomy, sometimes with cardiac bypass and cardiac arrest with hypothermia, when the thrombus reaches the diaphragmatic level or above. Pathology analysis of the thrombus can guide staging and the need for radiotherapy postoperatively. Results: A decision making fluxogram protocol is presented focusing on the surgical treatment of such condition. Conclusion: Surgery strategy is highly impacted by the presence of vascular extension in pediatric tumors. Surgeons should be aware of potential complications and how to prevent them. Such cases should be treated in reference centers.

Adiponectin is Increased in Pediatric Patients With Autoimmune Hepatitis Independent of Body Weight.

OBJECTIVE: A high prevalence of obesity is reported in children and adolescents with autoimmune hepatitis (AIH). Adipokines participate in inflammatory processes. The objective of this study was to examine the relationship between excess weight and systemic inflammation, adipokines, and ghrelin in adolescents with AIH. METHOD: This case-controlled study included 27 adolescents with AIH (13 with excess weight and 14 with normal weight) and a control group. Excess weight was defined by a body mass index/age Z score >+1 standard deviation. Adipokines (adiponectin, leptin, tumor necrosis factor alpha, interleukin 6 [IL-6], and IL-10) and ghrelin were measured with Luminex technology. RESULTS: Adiponectin (µg/mL) was higher (P < 0.001) in AIH adolescents with and without excess weight (median: 35.0 and 42.1, respectively) than in normal-weight (17.5) and excess-weight (17.0) controls. Leptin was higher (P < 0.001) in excess-weight AIH patients (18.0 ng/mL) and controls (19.8 ng/mL) than in normal-weight AIH (7.7 ng/mL) and control (7.0 ng/mL) adolescents. IL-6 levels were higher in excess-weight (3.8 pg/mL) and normal-weight (3.8 pg/mL) AIH patients than in excess-weight (1.1 pg/mL) and normal-weight (0.5 pg/mL) controls. IL-10 levels were higher (5.2 pg/mL) in normal-weight AIH patients than in excess-weight (1.8 pg/mL) and normal-weight (2.1 pg/mL) controls. Ferritin levels were lower in patients with AIH than in controls. CONCLUSIONS: Independent of body weight, AIH patients had higher levels of adipokines, especially adiponectin and IL-6. Leptin levels were associated with body weight and were not influenced by AIH. IL-10 levels were associated with lean tissue in AIH.

Temporal and Sequential Analysis of the Pharyngeal Phase of Swallowing in Poststroke Patients.

The purpose of this study was to conduct a quantitative analysis of the temporal and sequential events of the pharyngeal phase of swallowing in 45 poststroke patients who presented or did not present with supraglottic penetration and/or laryngotracheal aspiration and to compare the groups with each other and to a group of 46 patients with normal swallowing. All individuals were assessed by videofluoroscopy and the temporal and sequential measures for the swallowing of 3 mL and 5 mL of thickened liquid, 3 mL of liquid, and 3 mL and 5 mL of pasty were obtained by analyzing the recorded exams on Virtual Dub software. The following events were measured: time of maximal displacement and sustaining of the hyoid and larynx, duration of velopharyngeal sphincter (VS) and supraglottic closure, total inversion time of the epiglottis, duration of pharyngeal constriction, and duration of upper esophageal sphincter (UES) opening. For the analysis of the temporal sequence, the initial time of larynx and hyoid elevation, VS closure, epiglottic inversion, supraglottic closure, pharyngeal constriction, and opening of the UES were obtained. For 5 mL of thickened liquid, the maximum hyoid elevation time was greater for patients with normal swallowing and the time the supraglottis remained closed was higher in the aspirators group. The time of pharyngeal constriction during swallowing of 3 mL of thickened liquid was lower in the aspirators group. During the swallowing of 3 mL of thin liquid, it was observed that in the aspirators group, the larynx took longer to reach its maximum elevation and the epiglottis took longer to complete its total inversion. The analysis of the temporal sequence showed that patients in the aspirators group presented greater disorganization with significant alteration of the time interval between the events.

Angulação do osso hioide e segurança da deglutição pós-laringectomia parcial horizontal supracricóidea e cricohioidoepiglotopexia / Hyoid bone angle and swallowing safety post supracricoid horizontal partial laryngectomy and cricohyoidoepiglottopexy

RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.

ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.

A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers

ABSTRACT In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.

A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers.

In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.

Irinotecan and vincristine for the treatment of refractory desmoplastic small round cell tumor in a developing country: a case report.

INTRODUCTION: Desmoplastic small round cell tumor is an extremely rare and aggressive cancer that affects mainly adolescents and young adults. Despite multiple therapeutic strategies, most patients have resistant disease with very poor survival rates. CASE PRESENTATION: We present a case of a 10-year-old Caucasian boy with a desmoplastic small round cell tumor refractory to conventional treatment who exhibited a good response to alternative treatment. With use of irinotecan and vincristine in association with radiation therapy, a reduction of 96.9% of the dimensions of the target lesions compared with the initial image was observed. CONCLUSION: This chemotherapy regimen, in association with radiation therapy, demonstrated efficacy for refractory desmoplastic small round cell tumor in our patient, and it is cost-effective.

Cognitive map to support the diagnosis of solitary bone tumors in pediatric patients.

Abstract. OBJECTIVE: To present a cognitive map to support the radiological diagnosis of solitary bone tumors, as well as to facilitate the determination of the nature of the tumor (benign or malignant), in pediatric patients. MATERIALS AND METHODS: We selected 28 primary lesions in pediatric patients, and we identified the findings typically associated with each of the diagnoses. The method used for the construction of the final cognitive map was the Bayesian belief network model with backward chaining. RESULTS: We developed a logical, sequential structure, in the form of a cognitive map, based on the Bayesian belief network model, with the intention of simulating the sequence of human thinking, in order to minimize the number of unnecessary interventions and iatrogenic complications arising from the incorrect evaluation of bone lesions. CONCLUSION: With this map, it will be possible to develop an application that will provide support to physicians and residents, as well as contributing to training in this area and consequently to a reduction in diagnostic errors in patients with bone lesions.

OBJETIVO: Apresentar um mapa cognitivo para suporte na determinação da natureza benigna ou maligna, bem como no diagnóstico radiológico, de tumores ósseos solitários na faixa etária pediátrica. MATERIAIS E MÉTODOS: Foi realizada uma seleção de 28 lesões principais na faixa etária pediátrica e dos achados característicos e associados a cada um desses diagnósticos. O método utilizado para a construção da estrutura cognitiva final foi o modelo de rede de crenças bayesianas com a técnica de encadeamento regressivo. RESULTADOS: Foi desenvolvida uma estrutura lógica e sequencial no formato de um mapa cognitivo, segundo o modelo de rede de crenças bayesianas, na tentativa de simular o raciocínio humano sequencial e minimizar esforços e iatrogenias oriundas da avaliação equivocada de lesões ósseas. CONCLUSÃO: Com base nesse mapa, será possível oferecer um aplicativo para apoio a profissionais e residentes médicos e colaborar com o treinamento nessa área e, consequentemente, diminuir erros no diagnóstico de uma lesão óssea.

Cognitive map to support the diagnosis of solitary bone tumors in pediatric patients / Mapa cognitivo para suporte ao diagnóstico de tumores ósseos solitários na faixa pediátrica

Abstract Objective: To present a cognitive map to support the radiological diagnosis of solitary bone tumors, as well as to facilitate the determination of the nature of the tumor (benign or malignant), in pediatric patients. Materials and Methods: We selected 28 primary lesions in pediatric patients, and we identified the findings typically associated with each of the diagnoses. The method used for the construction of the final cognitive map was the Bayesian belief network model with backward chaining. Results: We developed a logical, sequential structure, in the form of a cognitive map, based on the Bayesian belief network model, with the intention of simulating the sequence of human thinking, in order to minimize the number of unnecessary interventions and iatrogenic complications arising from the incorrect evaluation of bone lesions. Conclusion: With this map, it will be possible to develop an application that will provide support to physicians and residents, as well as contributing to training in this area and consequently to a reduction in diagnostic errors in patients with bone lesions.

Resumo Objetivo: Apresentar um mapa cognitivo para suporte na determinação da natureza benigna ou maligna, bem como no diagnóstico radiológico, de tumores ósseos solitários na faixa etária pediátrica. Materiais e Métodos: Foi realizada uma seleção de 28 lesões principais na faixa etária pediátrica e dos achados característicos e associados a cada um desses diagnósticos. O método utilizado para a construção da estrutura cognitiva final foi o modelo de rede de crenças bayesianas com a técnica de encadeamento regressivo. Resultados: Foi desenvolvida uma estrutura lógica e sequencial no formato de um mapa cognitivo, segundo o modelo de rede de crenças bayesianas, na tentativa de simular o raciocínio humano sequencial e minimizar esforços e iatrogenias oriundas da avaliação equivocada de lesões ósseas. Conclusão: Com base nesse mapa, será possível oferecer um aplicativo para apoio a profissionais e residentes médicos e colaborar com o treinamento nessa área e, consequentemente, diminuir erros no diagnóstico de uma lesão óssea.

Can diffusion-weighted whole-body MRI replace contrast-enhanced CT for initial staging of Hodgkin lymphoma in children and adolescents?

BACKGROUND: Although positron emission tomography with 18F-fluoro-2-deoxyglucose (FDG-PET/CT) has been recommended as the method of choice for lymphoma staging, it has limited availability in several countries, therefore, studies comparing whole-body magnetic resonance imaging (MRI) to conventional staging methods or to FDG-PET/CT are an important tool to establish whole-body MRI as an alternative to these methods. OBJECTIVE: To compare whole-body MRI versus conventional imaging methods for staging of Hodgkin lymphoma in children and adolescents. MATERIALS AND METHODS: The study included 22 patients ages 5 to 21 years. Staging was performed using conventional imaging methods and whole-body MRI. Conventional imaging methods were defined as computed tomography (CT) of the neck, chest, abdomen and pelvis and ultrasonography of the neck and/or abdomen. We calculated the sensitivity of these methods for Hodgkin lymphoma staging and their sensitivity and specificity for detecting sites of nodal and extranodal involvement. RESULTS: The sensitivity of whole-body MRI for Hodgkin lymphoma staging was superior to that of conventional imaging methods (95.5% vs. 86.4%, respectively), but both methods had similar sensitivity and specificity for detecting involvement of nodal sites (99.1% and 100% vs. 97.3% and 100%, respectively) and extranodal sites (90.5% and 98.7% vs. 90.5% and 99.4%, respectively). CONCLUSION: Whole-body MRI has excellent sensitivity for staging of Hodgkin lymphoma in children and adolescents. It can thus be considered an alternative for this purpose, particularly because it does not expose patients to ionizing radiation.

DO THE RADIOLOGICAL CRITERIA WITH THE USE OF RISK FACTORS IMPACT THE FORECASTING OF ABDOMINAL NEUROBLASTIC TUMOR RESECTION IN CHILDREN?

BACKGROUND: The treatment of neuroblastoma is dependent on exquisite staging; is performed postoperatively and is dependent on the surgeon's expertise. The use of risk factors through imaging on diagnosis appears as predictive of resectability, complications and homogeneity in staging. AIM: To evaluate the traditional resectability criteria with the risk factors for resectability, through the radiological images, in two moments: on diagnosis and in pre-surgical phase. Were analyzed the resectability, surgical complications and relapse rate. METHODS: Retrospective study of 27 children with abdominal and pelvic neuroblastoma stage 3 and 4, with tomography and/or resonance on the diagnosis and pre-surgical, identifying the presence of risk factors. RESULTS: The mean age of the children was 2.5 years at diagnosis, where 55.6% were older than 18 months, 51.9% were girls and 66.7% were in stage 4. There was concordance on resectability of the tumor by both methods (INSS and IDRFs) at both moments of the evaluation, at diagnosis (p=0.007) and post-chemotherapy (p=0.019); In this way, all resectable patients by IDRFs in the post-chemotherapy had complete resection, and the unresectable ones, 87.5% incomplete. There was remission in 77.8%, 18.5% relapsed and 33.3% died. CONCLUSIONS: Resectability was similar in both methods at both pre-surgical and preoperative chemotherapy; preoperative chemotherapy increased resectability and decreased number of risk factors, where the presence of at least one IDRF was associated with incomplete resections and surgical complications; relapses were irrelevant.

ASSESSMENT OF THE LATE EFFECTS ON BONES AND ON BODY COMPOSITION OF CHILDREN AND ADOLESCENTS TREATED FOR ACUTE LYMPHOCYTIC LEUKEMIA ACCORDING TO BRAZILIAN PROTOCOLS. / AVALIAÇÃO DOS EFEITOS ÓSSEOS TARDIOS E COMPOSIÇÃO CORPORAL DE CRIANÇAS E ADOLESCENTES TRATADOS DE LEUCEMIA LINFOIDE AGUDA SEGUNDO PROTOCOLOS BRASILEIROS.

OBJECTIVE: To evaluate the impact of therapy on bone mineral density (BMD) and body composition in survivors of acute lymphoblastic leukemia (ALL) treated in accordance with Brazilian protocols by the Brazilian Cooperative Group of Treatment of Lymphoblastic Leukemia in Childhood (GBTLI) LLA-93 and LLA-99. METHODS: A cross-sectional study with 101 patients was performed. BMD and body composition were evaluated using bone densitometry and were interpreted according to the age group and the reference population. Values between -1.1 and -1.9 in the group of children under 20 years were considered as risk group for low BMD z-scores. BMD values were compared to clinical characteristics, treatment received and body composition. A chi-square test, Fisher's exact test, likelihood ratio and Student's t-test were applied, with a 5% significance level. RESULTS: The patients presented a frequency of fractures of 2%, of osteonecrosis, 2%, and of low BMD, 2.9%. In the group of 79 patients under 20 years of age, three had low BMD. The 16 that presented risk for low BMD, demonstrated lower valutes in lumbar vertebrae L1-L4 (p=0.01) and whole body (p=0.005), and smaller values of lean body mass (p=0.03). In the group of 22 patients over 20 years of age, ten had osteopenia. CONCLUSIONS: The low impact of treatment on BMD of this study confirms the concept that the bone mass gain occurs with increasing age and that the treatment does not influence the process. The population at risk for low BMD values presented lower bone mass values and could benefit from a long-term monitoring for possible bone toxicity.

OBJETIVO: Avaliar o impacto da terapia sobre a densidade mineral óssea (DMO) e composição corporal em sobreviventes da leucemia linfoide aguda (LLA), tratados de acordo com os protocolos brasileiros do Grupo Cooperativo Brasileiro de Tratamento de Leucemia Linfoide Aguda na Infância (GBTLI), LLA-93 e LLA-99. MÉTODOS: Em estudo transversal com 101 pacientes, avaliaram-se a composição corporal e a DMO por meio da densitometria óssea, interpretando-a conforme a faixa etária e a população de referência. Foi considerado grupo de risco para baixa DMO valores de z-escore entre -1,1 e -1,9 no grupo dos menores de 20 anos. Compararam-se os valores da DMO com características clínicas, tratamento recebido e composição corporal. Foram utilizados os testes qui-quadrado, exato de Fisher, razão de verossimilhança e t de Student, com nível de significância de 5%. RESULTADOS: Foram encontradas 2% de fraturas, 2% de osteonecrose e 2,9% de baixa DMO. No grupo de pacientes com menos de 20 anos, três apresentaram baixa DMO. Os 16 pacientes com risco para baixa DMO exibiram menores valores em vértebras lombares L1-L4 (p=0,01), corpo total (p=0,005) e valores mais baixos de massa magra (p=0,03). No grupo de 22 pacientes com mais de 20 anos, dez demonstraram osteopenia. CONCLUSÕES: O baixo impacto do tratamento sobre a DMO neste estudo ratifica o conceito de que o ganho de massa óssea ocorre com o aumento da idade e que o tratamento não influencia tal processo. A população de risco para baixa DMO demonstrou valores menores de massa óssea, podendo beneficiar-se de um acompanhamento em longo prazo para uma possível toxicidade óssea.