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¹²³I-MIBG Scintigraphy and ¹⁸F-FDG PET in Neuroblastoma

¹ Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ² Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee; ³ Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and ⁴ Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee

Correspondence: For correspondence or reprints contact: Susan E. Sharp, Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH 45229-3039. E-mail: susan.sharp{at}cchmc.org

The purpose of this study was to compare the diagnostic utility of ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy and ¹⁸F-FDG PET in neuroblastoma. Methods: A total of 113 paired ¹²³I-MIBG and ¹⁸F-FDG PET scans in 60 patients with neuroblastoma were retrospectively reviewed. Paired scans were acquired within 14 days of each other. Results: For stage 1 and 2 neuroblastoma (13 scans, 10 patients), ¹⁸F-FDG depicted more extensive primary or residual neuroblastoma in 9 of 13 scans. ¹²³I-MIBG and ¹⁸F-FDG showed equal numbers of lesions in 1 of 13 scans, and 3 of 13 scan results were normal. For stage 3 neuroblastoma (15 scans, 10 patients), ¹²³I-MIBG depicted more extensive primary neuroblastoma or local or regional metastases in 5 of 15 scans. ¹⁸F-FDG depicted more extensive primary neuroblastoma or local or regional metastases in 4 of 15 scans. ¹²³I-MIBG and ¹⁸F-FDG were equal in 2 of 15 scans, and 4 of 15 scan results were normal. For stage 4 neuroblastoma (85 scans, 40 patients), ¹²³I-MIBG depicted more neuroblastoma sites in 44 of 85 scans. ¹⁸F-FDG depicted more neuroblastoma sites in 11 of 85 scans. ¹²³I-MIBG and ¹⁸F-FDG were equivalent or complementary in 13 of 85 scans, and 17 of 85 scan results were normal. Conclusion: ¹⁸F-FDG is superior in depicting stage 1 and 2 neuroblastoma, although ¹²³I-MIBG may be needed to exclude higher-stage disease. ¹⁸F-FDG also provides important information for patients with tumors that weakly accumulate ¹²³I-MIBG and at major decision points during therapy (i.e., before stem cell transplantation or before surgery). ¹⁸F-FDG can also better delineate disease extent in the chest, abdomen, and pelvis. ¹²³I-MIBG is overall superior in the evaluation of stage 4 neuroblastoma, especially during initial chemotherapy, primarily because of the better detection of bone or marrow metastases.

Key Words: neuroblastoma • ¹²³I-MIBG • ¹⁸F-FDG PET

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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				S. E. Sharp, B. L Shulkin, M. J. Gelfand, and S. Salisbury Reply: 123I-MIBG Scintigraphy and 18F-FDG PET in Neuroblastoma J. Nucl. Med., February 1, 2010; 51(2): 331 - 331. [Full Text] [PDF]

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				N. C. Nguyen, D. Bhatla, and M. M. Osman 123I-MIBG Scintigraphy and 18F-FDG PET in Neuroblastoma J. Nucl. Med., February 1, 2010; 51(2): 330 - 331. [Full Text] [PDF]