INTRODUCTION
The frequency of pediatric head and neck neoplasms ranges from
approximately 2-15% of all pediatric cancers1. Skull base and
calvarial neoplasms, including temporal bone and orbital masses are a
subset of head and neck neoplasms occupying a number of neoplastic
processes and categorically encompass several imaging patterns: singular
dominant mass lesions with or without metastatic disease (e.g.,
rhabdomyosarcoma (RMS), chordoma), singular or multifocal metastatic
disease (e.g., neuroblastoma), and multifocal disease due to systemic
malignancy (e.g., leukemia, lymphoma, histiocytosis, etc.).
While pathologies certainly vary between pediatric and adult patients,
there remains significant overlap. As such, imaging protocols for skull
base and calvarial neoplasms are similar in their general construct.
However, optimized pediatric-specific protocols remain a must, as a
retrofitted adult head and neck protocol is often ill equipped to offer
quality, efficient and safe imaging (e.g., limiting radiation exposure)
of the size-variable infant and pediatric patient. Moreover, sedation or
general anesthesia is often required in the pediatric population in
order to minimize motion artifact. Thus, optimization of imaging
acquisition time is a very important technical consideration because it
may decrease the necessity and duration of sedation/anesthesia and their
potential risks in this vulnerable population. Standardized protocols
for anatomic sub sites of the head and neck offer significant benefit in
individual patient follow up on a local scale, and, on a broader scale,
allow for collaborative understanding of imaging pathologies and
innovative or benchmarked standardized treatment response assessment
across institutions.
In an effort to standardize protocols, this article offers minimum,
pediatric specific anatomy-based initial and follow up imaging
guidelines for pediatric malignancies of the orbits, calvarium, skull
base and temporal bone. This manuscript was funded in part by the
National Clinical Trials Network Operations Center Grant U10CA180886.
The content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of
Health.