Advertisement

Correlations Between Preoperative Radiographic Vascular Involvement of Abdominal/Pelvic Neuroblastomas on Computed Tomography and Intraoperative Vascular Injuries: Experience From a Tertiary Children's Hospital

  • Haoru Wang
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Ting Li
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Xin Chen
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Jin Zhu
    Affiliations
    Department of Pathology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Mingye Xie
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Li Zhang
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Hao Ding
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Jinjie Qin
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
  • Ling He
    Correspondence
    Address correspondence to: L.H.
    Affiliations
    Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing 400014, China
    Search for articles by this author
Published:October 09, 2022DOI:https://doi.org/10.1016/j.acra.2022.09.010

      Rationale and Objectives

      This research examines the prevalence and occurrence of intraoperative vascular injuries in abdominal or pelvic neuroblastomas. It also investigates the correlations between preoperative radiographic vascular involvement on computed tomography (CT) and intraoperative vascular injuries in abdominal or pelvic neuroblastomas.

      Materials and Methods

      This study enrolled 297 patients with abdominal or pelvic neuroblastomas. The relationships between neuroblastomas and adjacent arteries on preoperative CT were categorized as no contact, contact (less than 50% of vessel circumference involved), partial encasement (less than 100% of vessel circumference involved), and total encasement (100% of vessel circumference involved). Similarly, the relationships between neuroblastomas and adjacent veins on preoperative CT were categorized as no compression, flattened with a visible lumen, and flattened with an invisible lumen. Furthermore, the correlations between preoperative radiographic vascular involvement of neuroblastomas and intraoperative vascular injuries were analyzed.

      Results

      A total of 61 patients had intraoperative vascular injuries, among which 76 vessels suffered injuries. Venous injuries (66/76, 86.84%) were more common than arterial injuries (10/76, 13.16%). Moreover, venous injuries frequently occurred in the inferior vena cava (32/66, 48.48%), renal veins (19/66, 28.79%), and iliac veins (8/66, 12.12%). All the injured arteries exhibited a total encasement on preoperative CT, and no injury occurred when the arteries were contacted or partially encased. In total, 87.88% (58/66) of injured veins were flattened with a visible lumen on preoperative CT, whereas only 12.12% (8/66) of the injured veins were flattened with an invisible lumen.

      Conclusion

      Intraoperative injuries to veins occur more frequently than that to arteries in abdominal or pelvic neuroblastomas. Importantly, intraoperative injuries to veins may occur even if the veins are flattened with a visible lumen.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lundberg KI
        • Treis D
        • Johnsen JI
        Neuroblastoma heterogeneity, plasticity, and emerging therapies.
        Curr Oncol Rep. 2022; 24: 1053-1062https://doi.org/10.1007/s11912-022-01270-8
        • Nabavizadeh SA
        • Feygin T
        • Harding BN
        • et al.
        Imaging findings of patients with metastatic neuroblastoma to the brain.
        Acad Radiol. 2014; 21: 329-337https://doi.org/10.1016/j.acra.2013.10.016
        • Brodeur GM
        • Pritchard J
        • Berthold F
        • et al.
        Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment.
        J Clin Oncol. 1993; 11: 1466-1477https://doi.org/10.1200/JCO.1993.11.8.1466
        • Monclair T
        • Brodeur GM
        • Ambros PF
        • et al.
        The International Neuroblastoma risk group (INRG) staging system: an INRG Task Force report.
        J Clin Oncol. 2009; 27: 298-303https://doi.org/10.1200/JCO.2008.16.6876
        • Whittle SB
        • Smith V
        • Doherty E
        • et al.
        Overview and recent advances in the treatment of neuroblastoma.
        Expert Rev Anticancer Ther. 2017; 17: 369-386https://doi.org/10.1080/14737140.2017.1285230
        • Iehara T
        • Yoneda A
        • Yokota I
        • et al.
        Results of a prospective clinical trial JN-L-10 using image-defined risk factors to inform surgical decisions for children with low-risk neuroblastoma disease: a report from the Japan children's Cancer group neuroblastoma committee.
        Pediatr Blood Cancer. 2019; 66: e27914https://doi.org/10.1002/pbc.27914
        • Iehara T
        • Yoneda A
        • Kikuta A
        • et al.
        A phase II JN-I-10 efficacy study of IDRF-based surgical decisions and stepwise treatment intensification for patients with intermediate-risk neuroblastoma: a study protocol.
        BMC Pediatr. 2020; 20: 212https://doi.org/10.1186/s12887-020-02061-5
        • Irwin MS
        • Naranjo A
        • Zhang FF
        • et al.
        Revised neuroblastoma risk classification system: a report from the children's oncology group.
        J Clin Oncol. 2021; 39: 3229-3241https://doi.org/10.1200/JCO.21.00278
        • Warmann SW
        • Seitz G
        • Schaefer JF
        • et al.
        Vascular encasement as element of risk stratification in abdominal neuroblastoma.
        Surg Oncol. 2011; 20: 231-235https://doi.org/10.1016/j.suronc.2010.01.003
        • Brisse HJ
        • McCarville MB
        • Granata C
        • et al.
        Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma risk group project.
        Radiology. 2011; 261: 243-257https://doi.org/10.1148/radiol.11101352
        • Chen AM
        • Trout AT
        • Towbin AJ
        A review of neuroblastoma image-defined risk factors on magnetic resonance imaging.
        Pediatr Radiol. 2018; 48: 1337-1347https://doi.org/10.1007/s00247-018-4117-9
        • Fumino S
        • Kimura K
        • Iehara T
        • et al.
        Validity of image-defined risk factors in localized neuroblastoma: a report from two centers in Western Japan.
        J Pediatr Surg. 2015; 50: 2102-2106https://doi.org/10.1016/j.jpedsurg.2015.08.039
        • Yoneda A
        • Nishikawa M
        • Uehara S
        • et al.
        Can image-defined risk factors predict surgical complications in localized neuroblastoma?.
        Eur J Pediatr Surg. 2016; 26: 117-122https://doi.org/10.1055/s-0035-1566100
        • Kiely E
        A technique for excision of abdominal and pelvic neuroblastomas.
        Ann R Coll Surg Engl. 2007; 89: 342-348https://doi.org/10.1308/003588407X179071
        • Fati F
        • Pulvirenti R
        • Paraboschi I
        • et al.
        Surgical approaches to neuroblastoma: review of the operative techniques.
        Children (Basel). 2021; 8: 446https://doi.org/10.3390/children8060446
        • Mühling J
        • Eberherr C
        • Müller Höcker J
        • et al.
        Vessel adherent growth represents a major challenge in the surgical resection of neuroblastoma and Is associated with adverse outcome.
        J Pediatr Surg. 2019; 54: 2336-2342https://doi.org/10.1016/j.jpedsurg.2019.07.012
        • Delforge X
        • De Cambourg P
        • Defachelles AS
        • et al.
        Unresectable thoracic neuroblastic tumors: changes in image-defined risk factors after chemotherapy and impact on surgical management.
        Pediatr Blood Cancer. 2021; 68: e29260https://doi.org/10.1002/pbc.29260
        • Mansfield SA
        • McCarville MB
        • Lucas Jr, JT
        • et al.
        Impact of neoadjuvant chemotherapy on image-defined risk factors in high-risk neuroblastoma.
        Ann Surg Oncol. 2022; 29: 661-670
        • Burnand K
        • Barone G
        • McHugh K
        • Cross K
        Preoperative computed tomography scanning for abdominal neuroblastomas is superior to magnetic resonance imaging for safe surgical planning.
        Pediatr Blood Cancer. 2019; 66: e27955https://doi.org/10.1002/pbc.27955
        • Wang H
        • Chen X
        • Zhu J
        • et al.
        Changes in image-defined risk factors with neoadjuvant chemotherapy in pediatric abdominal neuroblastoma.
        Abdom Radiol (NY). 2022; 47: 3520-3530https://doi.org/10.1007/s00261-022-03596-0
        • Tucker WD
        • Arora Y
        • Mahajan K
        Anatomy, Blood Vessels. 2021;
        • Smillie RP
        • Shetty M
        • Boyer AC
        • et al.
        Imaging evaluation of the inferior vena cava.
        Radiographics. 2015; 35: 578-592https://doi.org/10.1148/rg.352140136
        • Castater CA
        • Carlin M
        • Parker VD
        • et al.
        Intra-abdominal inferior Vena cava injuries: operative strategies and outcomes.
        Am Surg. 2021; 87: 1316-1326https://doi.org/10.1177/0003134820973395
        • Tanaka Y
        • Kawashima H
        • Mori M
        • et al.
        Contraindications and image-defined risk factors in laparoscopic resection of abdominal neuroblastoma.
        Pediatr Surg Int. 2016; 32: 845-850https://doi.org/10.1007/s00383-016-3932-z
        • Shirota C
        • Tainaka T
        • Uchida H
        • et al.
        Laparoscopic resection of neuroblastomas in low- to high-risk patients without image-defined risk factors is safe and feasible.
        BMC Pediatr. 2017; 17: 71https://doi.org/10.1186/s12887-017-0826-8
        • Fischer J
        • Pohl A
        • Volland R
        • et al.
        Complete surgical resection improves outcome in INRG high-risk patients with localized neuroblastoma older than 18 months.
        BMC Cancer. 2017; 17: 520https://doi.org/10.1186/s12885-017-3493-0