A pictorial review of I-123 MIBG imaging in pediatric neuroblastoma utilizing the state-of-the-art CZT SPECT/CT system.

Aim: I-123 MIBG imaging is a valuable imaging modality for the diagnosis, staging, and restaging of neuroblastoma, particularly in children. NM/CT 870 CZT (GE Healthcare) is the state-of-the-art, general-purpose SPECT/CT system with a dual-head gamma camera equipped with cadmium zinc telluride (CZT) detectors, which is capable of imaging higher energy peaks and promises to provide improved image quality and lesion detection compared with conventional NaI gamma cameras. Its diagnostic capabilities with 99m-Tc based radiopharmaceuticals, e.g., for bone scanning and myocardial perfusion imaging, have been demonstrated in the literature; however, I-123 MIBG clinical data are scarce, particularly in pediatric neuroblastoma. This Educational Exhibit, in a pictorial review format, covers a wide range of acquisition protocol options and imaging findings related to clinical I-123 MIBG imaging in pediatric neuroblastoma and illustrates the capabilities as well as constraints of the current CZT SPECT/CT system.

Objectives: (1) To review planar acquisition protocols, including continuous vs. step-and-shot whole body and high-energy scatter correction, as well as imaging characteristics including lesion detection and image artifact. (2) To review SPECT/CT acquisition protocol and options for postprocessing (resolution recovery; high-energy scatter correction; post-filter), and imaging characteristics, including lesion detection and artifact. Solutions to avoid an artifact commonly seen around the patient's body are presented, which, if unsolved, can affect the image quality and interpretation of the maximum intensity projection (MIP) image.