Hall-Craggs, Margaret Anne; (1993) Malignant solid abdominal tumours in children; the role of high field MR in diagnosis and treatment. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Children with solid abdominal tumours are imaged using a combination of modalities including plain film radiography, ultrasound, computed tomography and radionucliedes. There is growing concern that, with the exception of ultrasound, these methods expose young children (who may undergo multiple investigations) to a significant dose of ionising radiation. Magnetic Resonance (MR) imaging has recently become available for use in clinical imaging and has the advantage of using radiofrequency (non-ionising) radiation. Therefore it is appropriate to determine whether MR can replace other ionising imaging techniques in the investigation of children with cancer and so reduce the risk of long-term side-effects. The purpose of the work reported in this thesis was to establish the efficacy of MR in the diagnosis, staging and assessment of response to treatment in a number of solid abdominal tumours occuring in children. As children can only be scanned successfully if they remain still during this lengthy and noisy procedure an effective means of sedating children had to be developed and two drug regimens were compared and their effectiveness for sedation are reported. In 3 clinical studies reported here, MR was used to diagnose, stage and monitor the effects of treatment in children with primary malignant hepatic tumours, renal tumours and neuroblastoma. The results of MR scanning was compared whereever possible with CT scans and surgical/histopathological data. In most cases MR was at least as successful as CT in diagnosing and assessing the extent of disease. The advantages and disadvantages of MR for assessing these tumours are discussed. In conclusion, we have also established that, with few reservations, MR is a good technique for diagnosing, staging and monitoring the response to treatment of these groups of solid abdominal tumours without the need for contrast agents or ionising radiation. We have also established an effective and reliable method of sedating children enabling high quality scans to be obtained routinely.

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