MRI findings related to Image Defined Risk Factors (IDRFs) in children with neuroblastic tumours: Analysis for structured reporting

Androniki Kozana, Vasiliki Fragkiadoulaki, Eftichia Stiakaki, Maria Raissaki


Neuroblastic tumours constitute a heterogenous group of tumours with diverse presentation, variable malignant behaviour and prognosis. Image Defined Risk Factors (IDRFs) have been described in the International Neuroblastoma Risk Group Staging System (INRGSS). IDRFs refer to compartmental involvement, the effect of masses to vital organs or anatomic structures and their relation to neurovascular bundles and airway. CT has been traditionally recommended for imaging children with neuroblastoma. MRI is increasingly being utilised for the diagnosis, staging and follow-up of children with neuroblastic tumours and is considered an acceptable modality for clinical trials. Appropriate structured reporting is crucial for communication with surgeons. This pictorial essay focuses on the MRI appearances of neuroblastic tumours, aims to familiarise radiologists with relevant terminology and the routine use of IDRFs when reporting MR imaging studies preoperatively; it provides a concise checklist of the INRGSS relevant parameters for complete preoperative assessment of children with neuroblastic tumours. This terminology and approach may also prove useful for reporting not only neuroblastic tumours but abdominal paediatric tumours in general. 


IDRFs; neuroblastoma; paediatric tumours; oncology; MRI; structured reporting

Full Text:



Cohn SL, Pearson AD, London WB, et al. The international neuroblastoma risk group (INRG) classification system: An INRG task force report. J Clin Oncol 2009; 27(2): 289–297.

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(1): 243-257.

Brodeur GM, Seeger RC, Barrett A, et al. International criteria for diagnosis, staging, and response to treatment in patients with neuroblastoma. J Clin Oncol 1988; 6(12): 1874-1881.

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(2): 298–303.

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(9): 845-850.

Irtan S, Brisse H, Minard-Colin V, et al .Minimally invasive surgery of neuroblastic tumors in children: Indications depend on anatomical location and image-defined risk factors. Pediatr Blood Cancer 2014; 62(2): 257-261.

Monclair T, Mosseri V, Cecchetto G, et al. Influence of image-defined risk factors on the outcome of patients with localised neuroblastoma. A report from the LNESG1 study of the European international society of paediatric oncology neuroblastoma group. Pediatr Blood Cancer 2015; 62(9): 1536-1542.

Günther P, Holland-Cunz S, Schupp C, et al. Significance of image-defined risk factors for surgical complications in patients with abdominal neuroblastoma. Eur J Pediatr Surg 2011; 21(05): 314-317.

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(01):117-122.

Pohl A, Erichsen M, Stehr M, et al. Image-defined risk factors correlate with surgical radicality and local recurrence in patients with neuroblastoma. Klin Padiatr 2016; 228(03): 118-123.

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(12): 2102-2106.

Hiorns M, Owens C. Radiology of neuroblastoma in children. Eur Radiol 2001; 11(10): 2071-2081.

Kembhavi SA, Shah S, Rangarajan V, et al. Imaging in neuroblastoma: An update. Indian J Radiol Imaging 2015; 25: 129-136.

Brody AS, Frush DP, Huda W, et al. Radiation risk to children from computed tomography. Pediatrics 2007; 120(3): 677–682.

Olsen ØE. Imaging of abdominal tumors: CT or MRI? Pediatr Radiol 2008; 38 (Suppl 3): S452-458.

Siegel M, Jaju A. MR Imaging of neuroblastic masses. Magn Reson Imaging Clin N Am 2008; 16(3): 499-513.

McHugh K, Fairhurst J. Paediatric neoplasms. In: Nicholson T (ed). Recommendations for cross-sectional imaging in cancer management, 2nd edition. The Royal College of Radiologists, London 2014. Ref No. BFCR(14)2.

Gahr N, Darge K, Hahn G, et al. Diffusion-weighted MRI for differentiation of neuroblastoma and ganglioneuroblastoma/ ganglioneuroma. Eur J Radiol 2011; 79(3): 443–446.

Chavhan GB, Babyn PS, Vasanawala SS. Abdominal MR imaging in children: motion compensation, sequence optimization, and protocol organization. Radiographics 2013; 33(3): 703-719.

Dias SC, Ølsen OE. Isotropic 3-D T2-weighted spin-echo for abdominal and pelvic MRI in children. Pediatr Radiol 2012; 42: 1385-1390.

McCarville M. Imaging neuroblastoma: what the radiologist needs to know. Cancer Imaging 2011;11 Spec No A: S44-47.

Weiss DL, Langlotz CP. Structured reporting: patient care enhancement or productivity nightmare? Radiology 2008; 249(3): 739-747.


  • There are currently no refbacks.