Related Experiment Video
Updated: Jul 10, 2026
Murine Bilateral Renal Lymphadenectomy
Published on: December 30, 2025
Bilateral disease and new trends in Wilms tumour
Catherine M Owens1, Hervé J Brisse, Øystein E Olsen
1Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK. OWENSC@gosh.nhs.uk
Insights
Wilms tumour surveillance guidelines are presented for genetically predisposed children, addressing inconsistent practices. New imaging techniques like PET-CT and diffusion-weighted MRI show promise for diagnosis and therapy response prediction.
Area of Science:
- Paediatric Oncology
- Medical Imaging
- Genetics
Background:
- Wilms tumour has an excellent prognosis, but surveillance imaging in genetically predisposed children lacks consistent protocols.
- Bilateral Wilms tumours present challenges in achieving cure while preserving renal function.
- Nephrogenic rests and nephroblastomatosis necessitate accurate imaging for diagnosis and characterization.
Purpose of the Study:
- To present evidence-based guidelines for Wilms tumour surveillance in the UK.
- To review current imaging modalities for bilateral renal disease in Wilms tumour.
- To discuss emerging imaging techniques for improved diagnosis and treatment monitoring.
Main Methods:
- Review of current Wilms tumour surveillance practices and available evidence.
- Multidisciplinary working group outlining UK guidelines.
- Discussion of diagnostic imaging strengths and weaknesses, including FDG-PET and MRI.
Main Results:
- Existing surveillance protocols are inconsistent, impacting equity of provision.
- FDG-PET-CT offers potential for staging, treatment response assessment, and planning.
- Diffusion-weighted imaging (DWI) with ADC maps may predict early therapy response.
Conclusions:
- Standardized Wilms tumour surveillance guidelines are needed for genetically predisposed children.
- Advanced imaging techniques like PET-CT and DWI hold promise for improved management of Wilms tumour.
- Further validation of quantitative MRI techniques in abdominal disease is warranted.
Abstract:
Wilms tumour is a great therapeutic success story within paediatric oncology; its prognosis is excellent. Although mainly sporadic, occurring in otherwise well children, it occurs in a small number of genetically predisposed children. Thus regular surveillance imaging is performed in predisposed children in parts of the USA and Europe. The risks and benefits of surveillance are unclear, as the existing ad-hoc surveillance protocols are lacking in consistency of practice and equity of provision. We present guidelines for Wilms tumour surveillance based on a review of current practice and available evidence, outlined by a multidisciplinary working group in the UK. Wilms tumours are bilateral in 4-13% of affected children. Bilateral synchronous nephroblastomas are observed in 5% of affected children and are usually associated with the presence of nephrogenic rests, congenital malformations and predisposing syndromes. The major challenge in bilateral disease is to achieve a cure and at the same time to preserve sufficient functional renal tissue for normal growth and development. The association among Wilms tumour, nephrogenic rests and nephroblastomatosis makes detection and characterization of renal lesions with imaging extremely important. We discuss the relative strengths and weaknesses of the different modalities used for diagnosis and follow-up in bilateral renal disease. We also discuss newly emerging diagnostic imaging tests such as (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET). This technique, when fused with CT (PET-CT), allows accelerated metabolic activity to be accurately anatomically localised and so is potentially useful for staging, assessment of treatment response, and for surgical and radiotherapy planning. In addition, quantitative MRI techniques have been proved to be valuable in intracranial tumours, but no such role has been validated in abdominal disease. Diffusion-weighted imaging with calculation of ADC maps is feasible in abdominal tumours, and our own preliminary data suggest that tissue cellularity is an important determinant of ADC value, which might help in terms of early prediction of therapy response.
