Imaging 'the lost tribe': a review of adolescent cancer imaging. Part 1

Abstract

Although a small proportion of all cancer registrations, malignancy in adolescence and young adulthood remains the most common natural cause of death in this age group. Advances in the management and outcomes of childhood cancer have not been matched within the adolescent population, with increasing incidence and poorer survival seen amongst teenagers with cancer compared with other populations. There have been increasing moves towards specific adolescent oncology centres, with the aim of centralizing expertise, however, 'adolescent imaging' does not exist as a specialty in the same way that paediatric imaging does, with responsibility for imaging adolescent patients sometimes falling to paediatric radiologists and sometimes to 'adult' radiologists, usually with a specific interest in a tumour type or body system. In this article, imaging of the more common malignancies, encountered in adolescent patients is reviewed. Complications of treatment are reviewed in another article to give an overview of adolescent oncology imaging practice.

Figure 1

Axial short time inversion recovery (STIR) MRI (TR 5.97, TE 60, TI 130 ms) of a patient with HL, showing a large mediastinal mass (long arrow), with direct lung infiltration (arrow heads) and a large pleural effusion (short arrow).

Figure 2

Coronal STIR MRI (TR 5.97, TE 60, TI 130 ms) and PET images of a patient with HL, before chemotherapy (A,C) and following 2 cycles of OEPA chemotherapy (vincristine, etoposide, prednisolone, doxorubicin) (B,D), showing a small change in size of a left supraclavicular nodal mass (long arrows), and inadequate metabolic response (arrow heads), with persistent PET positivity.

Figure 3

Coronal STIR MRI (TR 5.97, TE 60, TI 130 ms) and PET images of a patient with HL, before chemotherapy (A,B) and after 2 cycles of OEPA chemotherapy (C,D). Initial imaging shows large volume right cervical (long arrow) and supraclavicular fossa disease (short arrow), which is PET positive (arrow head). Following 2 cycles of OEPA there is residual disease within the right supraclavicular fossa (short arrow, image C), but there is no FDG uptake, indicating an adequate metabolic response.

Figure 4

Anterioposterior (AP) plain radiograph in a patient with EFT of the distal right tibia, demonstrating a lucent lesion with associated lamellated ‘onion skin’ periosteal reaction (short arrow) and a Codman triangle (arrow head).

Figure 5

Selected slice from wide field of view coronal T1-weighted MRI (TR 439, TE 14 ms) of the same patient as Fig. 3. Note intermediate signal intramedullary tumour (arrow) replacing the normal fatty marrow signal seen contralaterally.

Figure 6

Axial contrast-enhanced CT section of a mediastinal germ cell tumour demonstrating a large heterogeneous anterior mediastinal mass, containing areas of fat (short arrow) and calcification (arrow head).

Figure 7

Transverse ultrasound image of the left lobe of the thyroid and isthmus (short arrow). The left lobe of the thyroid contains a heterogeneous echogenicity nodule, with multiple small foci of calcification (between callipers). Fine-needle aspiration revealed papillary thyroid carcinoma.

Figure 8

Axial contrast-enhanced fat-saturated T1-weighted MRI (TR 567, TE 12 ms) of a patient with nasopharyngeal carcinoma (long arrow) invading the left parapharyngeal space, parotid and left maxillary antrum (short arrow), with multiple lymph node metastases (arrow heads).