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. 2025 Sep 2:15:1627403.
doi: 10.3389/fonc.2025.1627403. eCollection 2025.

[18F]mFBG PET/CT surpasses [18F]FDG PET/CT for evaluation of pediatric neuroblastoma

Wenqian Zhang #  1 , Chao Yang #  2 , Zhenzhen Zhao  2 , Shunhao Zhou  1 , Yanyao Han  1 , Chenxi Zheng  1 , Yalan Xiong  1 , Changchun Li  2 , Yao Zhang  2 , Zhenni Wang  2 , Liang Cai  1 , Shan Wang  2
Affiliations

[18F]mFBG PET/CT surpasses [18F]FDG PET/CT for evaluation of pediatric neuroblastoma

Wenqian Zhang et al. Front Oncol. .

Abstract

Purpose: [18F]FDG PET/CT serves as an alternative imaging modality for neuroblastoma in cases where [123I]MIBG yields negative results or is unavailable. [18F]mFBG, a novel PET tracer for neuroblastoma imaging, requires further clinical validation. This preliminary study aims to evaluate the efficacy of [18F]mFBG PET/CT compared to [18F]FDG PET/CT in detecting neuroblastoma.

Methods: In this retrospective investigation, 56 pediatric patients were enrolled. Each patient underwent both [18F]mFBG PET/CT and [18F]FDG PET/CT within one week. Two children underwent a second paired [18F]FDG-[18F]mFBG PET/CT scan. In total, 58 paired scans (mean age 47.6 ± 38.0 months, range 6-108 months) were performed. Two experienced readers measured normal organ uptake (SUVmean), lesion uptake (SUVmax), and tumor-to-background ratio (TBR). A lesion-by-lesion analysis was conducted to compare detection rates between [18F]mFBG and [18F]FDG.

Results: Twenty paired scans exhibited negative findings on both [18F]mFBG and [18F]FDG studies. Among the remaining 38 scans, 8 (21.05%) were [18F]mFBG-positive/[18F]FDG-negative, 1 (2.63%) was [18F]FDG-positive/[18F]mFBG-negative, and 29 (76.32%) were positive on both tracers. In these 38 scans, [18F]mFBG PET/CT identified 431 lesions, whereas [18F]FDG PET/CT detected only 162 lesions (p<0.001). Six of eight [18F]mFBG-positive/[18F]FDG-negative cases were histopathologically confirmed as neuroblastoma. The mean TBR of [18F]mFBG PET/CT(6.68 ± 5.76) was significantly higher (p<0.001) than that of [18F]FDG PET/CT (4.49 ± 2.88).

Conclusion: [18F]mFBG PET/CT detected more neuroblastoma lesions than [18F]FDG PET/CT, suggesting it may be a more viable alternative when standard [123I]MIBG scanning is not feasible.

Keywords: PET/CT; [18F]FDG; [18F]mFBG; neuroblastoma; norepinephrine transporter.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram shows participant selection details.
Figure 2
Figure 2
An 8-year-old boy with high-risk left retroperitoneal neuroblastoma received 1 cycle of chemotherapy. (a) [18F]mFBG images. Pathological uptake (red arrows) with SUVmax 8.9 and TBR 12.5 was noted in the left retroperitoneal mass, and detailed showed in axial images. (b) [18F]FDG images. Pathological uptake (blue arrows) with SUVmax 5.8 and TBR 11.9 was noted in the left retroperitoneal mass, and detailed show in axial images. Besides, residual activity of mFBG and FDG was found in the left thoracic entrance and retroperitoneal lymph nodes.
Figure 3
Figure 3
A 3-year-old girl suffered high-risk right retroperitoneal neuroblastoma with bone metastases and underwent resection of lesions followed by 8 cycles of chemotherapy. Post-therapy images were acquired. (a) [18F]mFBG images. Pathological uptake (red arrows) with SUVmax 5.1 and TBR 4.9 was noted in the abdominal paraaortic lymph nodes, and detailed showed in axial images. And residual activity of mFBG was found in bone/bone marrow in multiple parts of the body. (b) [18F]FDG images. No pathological uptake was found.
Figure 4
Figure 4
A 2-year-old boy suffered low-risk left retroperitoneal neuroblastoma and followed by 2 cycles of chemotherapy. Post-therapy images were acquired. (a) [18F]mFBG images. No residual activity was found. (b) [18F]FDG images. Abnormal activity (blue arrows) with SUVmax 5.0 and TBR 11.6 was found in the right retroperitoneal lymph node.
Figure 5
Figure 5
Therapy response evaluation of a 4-year-old boy suffered high-risk right retroperitoneal neuroblastoma underwent resection of lesions followed by 3 cycles of chemotherapy. (a) [18F]mFBG images. Pathological uptake was found in extensive lymph nodes and bone/bone marrow (red arrows). (b) [18F]FDG images. No residual activity was found.
Figure 6
Figure 6
Therapy response evaluation of a 4-year-old boy with high-risk right retroperitoneal neuroblastoma underwent resection of lesions followed by 8 cycles of chemotherapy. (a) [18F]mFBG images. Pathological uptake was found in the skull (red arrows). (b) [18F]FDG images. No residual activity was found in the same site.
See this image and copyright information in PMC

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