INTRODUCTIONThe 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.
