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Evaluation of Pediatric CNS Malignancies with ^99mTc-Methoxyisobutylisonitrile SPECT

¹ Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
² Department of Nuclear Medicine, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
³ Department of Pediatric Oncology, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada

SPECT has the potential to add valuable information to the diagnosis and management of central nervous system (CNS) malignancy. Radioactive tracers including ^99mTc-methoxyisobutylisonitrile (MIBI), or sestamibi, have been shown to be sensitive markers for brain tumors; however, their role in imaging children is poorly defined. Methods: We undertook a pilot study of 29 pairs of ^99mTc-MIBI and MRI images from 20 children to explore the clinical usefulness of this tracer in CNS malignancy. Results: Tumor types that took up ^99mTc-MIBI included brain stem glioma, fibrillary astrocytoma, other low-grade astrocytomas, and glioblastoma multiforme. Most tumors positive for ^99mTc-MIBI uptake were astrocytomas, including those in the brain stem, cerebellum, and cortex. This method of nuclear imaging not only was able to identify the presence of a tumor but also could identify changes in the same tumor over time. Some correlation between histologic grade and ^99mTc-MIBI uptake was observed. Several tumors, including craniopharyngioma, medulloblastoma, and optic glioma, were evident on MRI but not on ^99mTc-MIBI SPECT. Conclusion: The results suggest that this modality is a potentially useful tool in the diagnosis and management of CNS malignancies, particularly higher-grade astrocytomas, in children.

Key Words: sestamibi • brain tumor • child • SPECT