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Review
. 2021 Apr 4;11(4):270.
doi: 10.3390/jpm11040270.

Nuclear Medicine Imaging in Neuroblastoma: Current Status and New Developments

Atia Samim  1   2 , Godelieve A M Tytgat  1 , Gitta Bleeker  3 , Sylvia T M Wenker  1   2 , Kristell L S Chatalic  1   2 , Alex J Poot  1   2 , Nelleke Tolboom  1   2 , Max M van Noesel  1 , Marnix G E H Lam  2 , Bart de Keizer  1   2
Affiliations
Review

Nuclear Medicine Imaging in Neuroblastoma: Current Status and New Developments

Atia Samim et al. J Pers Med. .

Abstract

Neuroblastoma is the most common extracranial solid malignancy in children. At diagnosis, approximately 50% of patients present with metastatic disease. These patients are at high risk for refractory or recurrent disease, which conveys a very poor prognosis. During the past decades, nuclear medicine has been essential for the staging and response assessment of neuroblastoma. Currently, the standard nuclear imaging technique is meta-[123I]iodobenzylguanidine ([123I]mIBG) whole-body scintigraphy, usually combined with single-photon emission computed tomography with computed tomography (SPECT-CT). Nevertheless, 10% of neuroblastomas are mIBG non-avid and [123I]mIBG imaging has relatively low spatial resolution, resulting in limited sensitivity for smaller lesions. More accurate methods to assess full disease extent are needed in order to optimize treatment strategies. Advances in nuclear medicine have led to the introduction of radiotracers compatible for positron emission tomography (PET) imaging in neuroblastoma, such as [124I]mIBG, [18F]mFBG, [18F]FDG, [68Ga]Ga-DOTA peptides, [18F]F-DOPA, and [11C]mHED. PET has multiple advantages over SPECT, including a superior resolution and whole-body tomographic range. This article reviews the use, characteristics, diagnostic accuracy, advantages, and limitations of current and new tracers for nuclear medicine imaging in neuroblastoma.

Keywords: [11C]mHED; [123I]mIBG; [124I]mIBG; [18F]F-DOPA; [18F]FDG; [18F]mFBG; [68Ga]Ga-DOTA peptides; neuroblastoma; nuclear medicine; radionuclide imaging.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Scoring systems for mIBG scintigraphy. The Curie score (a) consists of 9 osteomedullary segments and a 10th soft tissue segment. Each segment is graded as: 0, no involvement; 1, one distinct lesion; 2, two or more distinct lesions; or 3, >50% involvement [27]. The International Society of Pediatric Oncology Europe Neuroblastoma Group (SIOPEN) score (b) consists of 12 osteomedullary segments. Each segment is graded as: 0, no involvement; 1, one distinct lesion; 2, two distinct lesions; 3, three distinct lesions; 4, four or more distinct lesions or <50% involvement; 5, >50% involvement; or 6, >95% diffuse involvement [28].
Figure 2
Figure 2
Example of a neuroblastoma patient with extensive metastasis who underwent [123I]mIBG and [18F]mFBG imaging within 1 day. These figures illustrate the superior image quality and tumor delineation of (a) [18F]mFBG PET maximum intensity projection and (c) axial PET-CT due to higher spatial resolution, higher tumor-to-background contrast, and improved counting statistics compared to (b) [123I]mIBG planar scintigraphy and (d) axial single-photon emission computed tomography with computed tomography (SPECT-CT).
Figure 3
Figure 3
Example of a patient with neuroblastoma, showing diffuse pathological but faint osteomedullary uptake on planar [123I]mIBG scintigraphy (a), without increased uptake on [18F]FDG positron emission tomography (PET) maximum intensity projections (MIP) (b), but extensive pathological osteomedullary uptake on [68Ga]Ga-DOTATATE PET MIP (c). Note the different physiological distribution between tracers.
See this image and copyright information in PMC

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