Perfusion imaging of neuroblastoma and nephroblastoma in a paediatric population using pseudo-continuous arterial spin-labelling magnetic resonance imaging

Objectives To examine the feasibility of performing ASL-MRI in paediatric patients with solid abdominal tumours. Methods Multi-delay ASL data sets were acquired in ten paediatric patients diagnosed with either a neuroblastoma (n = 4) or nephroblastoma (n = 6) during a diagnostic MRI examination at a single visit (n = 4 at initial staging, n = 2 neuroblastoma and n = 2 nephroblastoma patients; n = 6 during follow-up, n = 2 neuroblastoma and n = 4 nephroblastoma patients). Visual evaluation and region-of-interest (ROI) analyses were performed on the processed perfusion-weighted images to assess ASL perfusion signal dynamics in the whole tumour, contralateral kidney, and tumour sub-regions with/without contrast enhancement. Results The majority of the included abdominal tumours presented with relatively low perfusion-weighted signal (PWS), especially compared with the highly perfused kidneys. Within the tumours, regions with high PWS were observed which, at short PLD, are possibly related to labelled blood inside vessels and at long PLD, reflect labelled blood accumulating inside tumour tissue over time. Conversely, comparison of ASL perfusion-weighted image findings with T1w enhancement after contrast administration showed that regions lacking contrast enhancement also were void of PWS. Discussion This pilot study demonstrates the feasibility of utilizing ASL-MRI in paediatric patients with solid abdominal tumours and provides a basis for further research on non-invasive perfusion measurements in this study population.

In the Shadows of Patients with Upper Gastrointestinal Cancer: An Interview Study with Next of Kin about Their Experiences Participating in Surgical Cancer Care

The study aimed to explore the experiences of participation among the next of kin of patients who had surgery for upper abdominal tumours. This study had a qualitative research design and data were analysed by thematic analysis. Eleven qualitative interviews were conducted with next of kin to patients who had surgery for liver, bile duct or pancreatic malignancy. The following themes emerged: from the shadows to an important role and an inviting and inhibiting environment for participation. Next of kin were a central part of their loved one’s care but often in the shadows. The next of kin described how they were not always invited and often they had to struggle to get involved. Next of kin often have a major psychosocial role to supporting the patient during and after discharge, and therefore need to be invited and involved in the whole care process.

Interesting pancreatic tumour in the background of Tuberous Sclerosis

Tuberous Sclerosis Complex (TSC) is easily discernible by a myriad of manifestations, most notably dermatological. It is associated with well known and recognised intra-abdominal tumours like angiomyolipoma of the kidney. However, rarer tumours like pancreatic neuroendocrine tumours can occur in the setting of TSC. A high index of suspicion is necessary to identify and treat these lesions early in their natural course. Early identification augurs well with complete surgical excision and excellent survival.

Study on clinical profile and management of abdominal tumours in children

Background: The discovery of an abdominal mass in a child usually presents a challenging problem in the diagnosis and treatment to the paediatrician, surgeon and urologist. Because of the heterogenicity of the lesion knowledge of differential of a mass in abdomen is essential for the logical evaluation of a child.Methods: The present study comprises of 25 children who presented with an intra-abdominal mass were included. The medical causes of the abdominal masses i.e. hepatosplenomegaly and leukemias were excluded. All patients admitted were routine investigated and whichever necessary. After the diagnosis, surgery was done wherever indicated and post-operatively the diagnosis was confirmed after the histopathological report.Results: All the cases presented with mass in abdomen while the other presentations were pain in abdomen (36%), fever (20%) and haematuria and vomiting (16% each). It was found that 64% of the masses were urological in origin while 36% of the masses were non-urological in origin. 21 (84%) patients underwent surgery, 10 (40%) patients took chemotherapy, 9 (36%) patients took radiotherapy.Conclusions: Routine investigations were only helpful in diagnosing the infection in infecting cases. Most reliable specific investigation was intravenous pyelography. It was found that majority of the abdominal masses in children were arising from urinary system. Correlation between pre-operative and post-operative diagnosis was found almost consistent.