I-123-MIBG scintigraphy and [F-18]FDG PET in neuroblastoma

Abstract

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Objectives: To evaluate I-123-m-iodobenzylguanidine (MIBG) and [F-18]fluorodeoxyglucose (FDG) PET for detection of primary and metastatic neuroblastoma (NBL).

Methods: 113 paired I-123-MIBG and FDG PET scans in 61 patients with NBL were retrospectively reviewed. Paired scans (pairs) were acquired within 14 days of each other, 86 pairs at a pediatric cancer hospital and 27 at a children's hospital.

Results: Stage 1/2 NBL (13 pairs, 10 patients): FDG depicted more extensive primary or residual NBL in 7/10 patients. MIBG and FDG were equal in 1/10. 2/10 were normal after tumor resection. Stage 3/4 NBL at diagnosis (21 pairs, 21 patients): MIBG depicted more bone/marrow metastases (mets) in 9/21 patients. FDG was superior in 4/21 for depiction of primary tumor, local/regional mets, and/or bone/marrow mets. MIBG and FDG were equal in 7/21. 1/21 was normal after tumor resection. Stage 3/4 NBL during initial 21 months of follow-up (53 pairs, 29 patients): MIBG was superior in 18/29 patients depicting more bone/marrow mets in 10/18, more local/regional mets in 4/18, more extensive primary tumor in 3/18, and more mets at all sites in 1/18. FDG was superior in 5/29 patients for depiction of local/regional and/or bone/marrow mets. MIBG and FDG were equal in 1/29. 5/29 were normal. Stage 3/4 NBL more than 21 months after diagnosis (26 pairs, 14 patients): MIBG was superior in 7/14 patients depicting more bone/marrow mets in 5/7 and more local/regional mets in 2/7. FDG was superior in 2/14 patients, depicting more local/regional mets. MIBG and FDG were equal in 1/14. 4/14 were normal.

Conclusions: FDG was superior to MIBG in stage 1/2 NBL, although MIBG may be needed to exclude higher stage disease. MIBG is often superior to FDG in the evaluation of stage 3/4 NBL, especially in detection of bone/marrow mets.