Figure 1. There is extensive bulky retroperitoneal lymphadenopathy. The IVC, aorta, and the aortic branches are encased. There is hypermetabolic left supraclavicular (SUV_max 4.0) lymphadenopathy.

Figure 2. There is a hypermetabolic (SUV_max 4.4), bulky right retroperitoneal mass that replaces the right adrenal gland. The right kidney is displaced inferiorly, and the upper pole appears infiltrated by the mass. There is lateral extension to Morrison's pouch. There is superior extension to the porta hepatis. The left adrenal gland appears normal.

Figure 3. There is an enhancing, hypermetabolic lung nodule (SUV_max 5.6). There is hypermetabolic mediastinal (SUV_max 3.2) lymphadenopathy. Increased diffuse and focal bone marrow FDG uptake is present in the axial skeleton, ribs, scapulae, proximal humeri, proximal femora and mandible (highest SUV_max 3).

Neuroblastoma is the most common extracranial solid paediatric tumour, and usually occurs in children younger than 5 years. They most commonly arise intra-abdominally, from the adrenal medulla or retroperitoneal sympathetic ganglia. Staging depends on lymph node involvement, whether the tumour crosses the midline, and the presence of distal metastases.

Neuroblastomas have been traditionally imaged with the radioiodinated norepinephrine analogue, metaiodobenzylguanidine (MIBG), owing to the capacity of neuroblastomas to accumulate catecholamine-like agents. Imaging evaluation includes MIBG, CT/MRI and ⁹⁹Tc bone scan. The use of FDG in neuroblastoma has been found to be equal or superior to MIBG in soft tissue and extracranial skeletal lesions, and PET/CT has been suggested to be a ‘one-stop-shop’ for imaging evaluation of this tumour. FDG has also been found to be helpful in defining the distribution of neuroblastomas that fail to concentrate MIBG.