Abstract
Introduction: 3D imaging and surgical planning for the treatment of embryonal tumors using different
techniques (CT versus MRI) are presently under discussion. Up to now, the main focus
has been on visualizing the anatomy. Contrast medium dynamics have not been taken
into consideration. The aim of the present study was to establish the technical means
of integrating the 3D images from functional MRI data into the anatomical images and
to determine clinical applications for this approach. Material and Methods: In 11 patients (mean age: 2.4 years) with solid tumors, 26 diagnostic MRI examinations
were performed for primary diagnosis, treatment monitoring, or as part of the surgical
planning. Seven children presented with neuroblastomas, three with Wilms' tumor, and
one with advanced bilateral nephroblastomatosis. The MRI data were acquired using
a 1.5-T system. For post-processing, we used volume rendering software, including
an evaluation of perfusion. By using color-coded parametric images and integrating
functional information, perfusion could be visualized and used for interactive surgical
planning. Macroscopic and microscopic sections served as the gold standard for assessing
tissue viability. Results: We were able to integrate the dynamic data into the anatomical images for all patients.
A good agreement was found between the results of surgical planning, including perfusion
mapping, with the surgical site, subsequently produced macroscopic sections and the
results of random microscopic examinations. Conclusions: Perfusion mapping using color-coded parametric images of pediatric abdominal tumors
extends the diagnostic techniques currently available. We provide first proof of the
possibility of integrating functional information into 3D MR images in children. Monitoring
the treatment of nephroblastoma and surgical planning for pediatric embryonal tumors
represent potential applications of this technique.
Key words
tumor - perfusion - three‐dimensional - child - magnetic resonance imaging (MRI)
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Dr. Patrick Günther
Division of Pediatric Surgery
University of Heidelberg
Im Neuenheimer Feld 110
69120 Heidelberg
Germany
Email: patrick.guenther@med.uni-heidelberg.de
