Imaging of neuroblastoma in patients identified by mass screening using urinary catecholamine metabolites

Between April 1983 and August 1991, mass screening in Chiba Prefecture found 25 infants to be positive for neuroblastoma based on elevated urinary levels of catecholamine metabolites. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy (BS), and 67Ga scintigraphy (GS) detected neuroblastomas in 12 of the 25 infants. The primary site of tumor was the mediastinum in 1 patient, the adrenal gland in 7, retroperitoneum in 3, and pelvis in 1. To determine the accuracy of each imaging technique, the percent sensitivity (SE), percent specificity (SP), and percent accuracy (AC) were determined for each technique from surgical findings and a follow-up study. MRI showed the highest diagnostic accuracy (100% for SE, SP, and AC), followed by CT (100%, 92%, 96%), US (82%, 92%, 88%), BS (58%, 100%, 80%), and GS (42%, 85%, 64%) in that order. MRI is most suitable for the imaging of individuals judged to be positive in the mass screening for neuroblastoma because of the advantages of visualization of the spread of tumor and the relationship of tumor to the great blood vessels, important determinants of resectability and therapy.