Research ArticleCLINICAL INVESTIGATIONS

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

Susan E. Sharp, Barry L. Shulkin, Michael J. Gelfand, Shelia Salisbury and Wayne L. Furman
Journal of Nuclear Medicine August 2009, 50 (8) 1237-1243; DOI: https://doi.org/10.2967/jnumed.108.060467

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    A 3-year-old boy with stage 2 neuroblastoma at diagnosis. (A) 18F-FDG anterior maximum-intensity-projection image demonstrates marked uptake in left thoracic paraspinal tumor and left supraclavicular metastatic lymph nodes. Uptake is also seen within dependent right upper lobe, corresponding to inflammatory airspace disease. (B) 123I-MIBG anterior and posterior planar images demonstrate minimal uptake in left thoracic paraspinal tumor.

  • FIGURE 2. 
    FIGURE 2. 

    A 3-month-old boy with stage 3 neuroblastoma at diagnosis. (A) 18F-FDG anterior maximum-intensity-projection image demonstrates marked uptake in the abdominal mass and mild diffuse physiologic uptake in the bone marrow. (B) 123I-MIBG anterior planar image demonstrates minimal uptake in abdominal mass, slightly above background.

  • FIGURE 3. 
    FIGURE 3. 

    A 3-year-old boy with stage 4 neuroblastoma before bone marrow transplantation. (A) 18F-FDG anterior maximum-intensity-projection image demonstrates marked uptake in retroperitoneal and mediastinal disease. Uptake is also seen in bony disease, most marked in lumbar spine and proximal femurs. (B) 123I-MIBG anterior and posterior planar images demonstrate retroperitoneal uptake.

  • FIGURE 4. 
    FIGURE 4. 

    A 13-year-old boy with stage 4 neuroblastoma after initial chemotherapy. (A) 18F-FDG anterior maximum-intensity-projection image demonstrates mild diffuse bone marrow uptake extending throughout axial and appendicular skeleton in response to marrow expansion with some G-CSF stimulation. (B) 123I-MIBG anterior planar image demonstrates uptake in diffuse bone or marrow metastases. Note absence of 123I-MIBG uptake in mid- or distal humerus and mid- or distal tibia. G-CSF = granulocyte colony-stimulating factor.

  • FIGURE 5. 
    FIGURE 5. 

    A 6-year-old girl with stage 4 neuroblastoma. (A) 18F-FDG anterior maximum-intensity-projection image obtained at diagnosis demonstrates uptake in primary left retroperitoneal tumor (arrows) and multiple discrete bone or marrow metastases. 123I-MIBG imaging at diagnosis (not shown) demonstrated uptake in primary tumor and multiple bone or marrow metastases. (B) 18F-FDG anterior maximum-intensity-projection image obtained after chemotherapy and G-CSF therapy demonstrates intense diffuse bone marrow uptake, obscuring or mimicking metastatic disease. 123I-MIBG images at follow-up (not shown) demonstrated resolution of uptake in primary tumor and bone or marrow metastases. Bone marrow sampling at time of follow-up scan showed no evidence of metastatic tumor. G-CSF = granulocyte colony-stimulating factor.

Tables

  • TABLE 1

    Summary of Results

    Result
    Stage123I-MIBG > 18F-FDG18F-FDG > 123I-MIBGEquivalentNegative
    Stage 1 and 2 neuroblastoma (13 scans/10 patients*)
     Diagnosis—4 scans/4 pts1 scan/1 pt—
     Follow-up—5 scans/3 pts—3 scans/3 pts
     Total—9 scans/6 pts1 scan/1 pt3 scans/3 pts
    Stage 3 neuroblastoma (15 scans/10 patients*)
     Diagnosis—1 scan/1 pt2 scans/2 pts—
     Follow-up5 scans/4 pts3 scans/3 pts—4 scans/3 pts
     Total5 scans/4 pts4 scans/4 pts2 scans/2 pts4 scans/3 pts
    Stage 4 neuroblastoma (85 scans/40 patients*)
     Diagnosis8 scans/8 pts3 scans/3 pts5 scans/5 pts—
     Follow-up ≤ 12 months19 scans/12 pts5 scans/3 pts5 scans/5 pts6 scans/5 pts
     Follow-up > 12 months17 scans/10 pts3 scans/3 pts3 scans/3 pts11 scans/10 pts
     Total44 scans/24 pts11 scans/8 pts13 scans/11 pts17 scans/14 pts

    • ↵* Patients with more than 1 scan during study period may be listed in different categories (i.e., patients scanned at both diagnosis and follow-up or patients with multiple follow-up scans with different results).

    • 123I-MIBG > 18F-FDG = numbers of scans and patients for which 123I-MIBG detected more lesions; pts = patients; 18F-FDG > 123I-MIBG = numbers of scans and patients for which 18F-FDG detected more lesions; Equivalent = numbers of scans and patients for which 123I-MIBG and 18F-FDG detected similar or complementary numbers and distributions of lesions; Negative = numbers of scans and patients for which 123I-MIBG and 18F-FDG study results were normal.

  • TABLE 2

    Summary of PET-Only Studies

    Result
    Stage123I-MIBG > 18F-FDG18F-FDG > 123I-MIBGEquivalentNegative
    Stage 1 neuroblastoma (5 scans/3 patients*)
     Diagnosis—2 scans/2 pts——
     Follow-up—3 scans/1 pt——
     Total—5 scans/3 pts——
    Stage 4 neuroblastoma (8 scans/5 patients*)
     Diagnosis1 scan/1 pt———
     Follow-up ≤ 12 months1 scan/1 pt———
     Follow-up > 12 months2 scans/2 pts1 scan/1 pt1 scan/1 pt2 scans/2 pts
     Total4 scans/4 pts1 scan/1 pt1 scan/1 pt2 scans/2 pts

    • ↵* Patients with more than 1 scan during study period may be listed in different categories (i.e., patients scanned at both diagnosis and follow-up or patients with multiple follow-up scans with different results).

    • 123I-MIBG > 18F-FDG = numbers of scans and patients for which 123I-MIBG detected more lesions; pts = patients; 18F-FDG > 123I-MIBG = numbers of scans and patients for which 18F-FDG detected more lesions; Equivalent = numbers of scans and patients for which 123I-MIBG and 18F-FDG detected similar or complementary numbers and distributions of lesions; Negative = numbers of scans and patients for which 123I-MIBG and 18F-FDG study results were normal.

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