Article Figures & Data
Figures
- FIGURE 1.
PET images obtained in list mode in 30-s increments, excluding periods of motion artifacts in reconstruction of images.
- FIGURE 2.
Sagittal and axial view of tracer uptake in pineal gland (arrows, A) and pituitary gland (arrows, B) seen on [18F]MFBG LAFOV PET/MRI. A = anterior; P = posterior.
- FIGURE 3.
(A) [18F]MFBG LAFOV PET/ULD CT (top) and [123I]MIBG scintigraphy with SPECT/LD CT images (bottom) of 7-wk-old girl with neuroblastoma. [18F]MFBG image shows intraspinal and bone marrow involvement not seen on [123I]MIBG image. [18F]MFBG PET/ULD CT image shows uptake in tumor in right hemithorax with intraspinal involvement with direct extension into neural foramina and spinal canal between thoracic vertebrae 4/5 and 5/6 (top red arrow), several liver lesions (middle red arrow), and in bone marrow of right tibia (bottom red arrow). [123I]MIBG scintigraphy with SPECT/LD CT image shows only large thoracic tumor (top purple arrow) and liver metastases (bottom purple arrow). Spinal involvement and bone marrow involvement could not be identified on [123I]MIBG scintigraphy with SPECT/LD CT. (B) [18F]MFBG LAFOV PET/ULD CT and [123I]MIBG scintigraphy with SPECT/LD CT images of 6-y-old girl with paravertebral relapse of neuroblastoma stage IV in left adrenal gland without N-Myc gene amplification. [18F]MFBG image shows lymph node involvement not seen on [123I]MIBG image. [18F]MFBG PET/ULD CT postoperative image, after resection of paravertebral relapse, shows uptake in left-side cervical lymph node (top left red arrows) and 2 retroperitoneal lymph nodes (top right red arrows), not identified on [123I]MIBG scintigraphy with SPECT/LD CT. A = anterior; MIP = maximum-intensity projection.
Tables
- TABLE 1.
Acquisition Protocols for [123I]MIBG Scintigraphy with SPECT/CT in Clinical Routine and [18F]MFBG LAFOV PET/CT
Parameter [123I]MIBG scintigraphy with SPECT/CT [18F]MFBG LAFOV PET/CT Acquisition time ∼150 min* 5–10 min Effective dose of tracer 3.7 mSv 1.7–3.4 mSv Time from injection to scan 24 h after injection 60 min after injection Protocol length 2 d 1 d GA or sedation Yes† No Age range Procedure 0–9 mo PET/CT planned during nap time Parents contacted and procedure and preparation explained at least 1–2 d before scheduled scan Sleep and food deprivation, advised starting 1–2 h before scan Wrapped, fed, and rested in scanner room Scanned without GA or sedation with activity of 1.5 MBq/kg 9 mo to 3 y PET/CT planned during nap time Parents contacted and procedure and preparation explained at least 1–2 d before scheduled scan Sleep and food deprivation, advised starting 1–2 h before scan Wrapped if possible, light dimmed, fed and rested in scanner room Scanned without GA or sedation at activity of 3 MBq/kg* ≥4 y Parents contacted and preparation explained at least 1–2 d before scan Food and drink with lower glycemic index to keep child calm offered in tracer uptake period In scanner room, light is dimmed and story is read by parents or caretakers Scan performed without GA or sedation at activity of 1.5 MBq/kg ↵* To be able to reconstruct in only 2 min.
Stage Definition L1 Localized tumor without image-defined risk factors for surgery L2 Locoregional tumor with image-defined risk factors M Metastatic MS Metastatic in infant < 18 mo old with metastases limited to liver, skin, and bone marrow Structure SUV Ratio with liver SUV Pituitary gland 1.1 (0.4–2.6) 0.3 (0.2–0.9) Pineal gland 0.7 (0.2–2.1) 0.2 (0.0–0.4) Lacrimal glands 3.3 (0.8–6.5) 0.9 (0.6–1.3) Parotid glands 6.4 (3.0–10.6) 2.6 (1.0–4.4) Submandibular glands 8.4 (4.1–13.1) 2.8 (1.3–5.6) Thyroid gland 5.0 (1.3–9.9) 1.4 (0.9–2.0) Heart 6.4 (3.2–9.0) 1.8 (1.1–2.0) Intestines 2.1 (1.0–2.5) 0.6 (0.5–0.7) Brown fat 1.6 (1.5–1.7) 0.4 (0.4–0.5) Pancreas 4.2 (1.0–6.6) 1.2 (0.7–1.8) Liver 4.0 (3.7–4.9) Data are average and range.
- TABLE 5.
Comparison of SIOPEN Scores, Curie Scores, and Lesion Counts for [123I]MIBG Scintigraphy with SPECT/CT and [18F]MFBG LAFOV PET/CT
Patient Tracer SIOPEN score Curie score Lesion count [18F]MFBG addition 1 [18F]MFBG 2 3 3 Bone marrow involvement [123I]MIBG 0 1 1 2 [18F]MFBG 1 4 4 Intraspinal involvement and bone marrow involvement [123I]MIBG 0 3 2 3 [18F]MFBG 17 12 21 Bone marrow involvement [123I]MIBG 0 0 0 4 [18F]MFBG 0 3 2 Confidence in intraspinal involvement [123I]MIBG 0 3 1 5 [18F]MFBG 0 0 0 No addition [123I]MIBG 0 0 0 6 [18F]MFBG 4 6 9 Confidence in intraspinal involvement and bone marrow involvement [123I]MIBG 0 3 2 7 [18F]MFBG 0 2 3 LN cerv. and retro. [123I]MIBG 0 0 0 8 [18F]MFBG 4 7 8 LN cerv., retro., iliac, and bone marrow involvement [123I]MIBG 3 6 3 9 [18F]MFBG 0 1 1 No addition [123I]MIBG 0 1 1 10 [18F]MFBG 0 2 3 LN retro. [123I]MIBG 0 1 1 LN = lymph node; cerv. = cervical; retro. = retroperitoneal.
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