In 1979/80 meta-iodobenzylguanidine (MIBG) was introduced as a radiopharmaceutical agent with high affinity to the adrenal medulla. It could be shown, that scintigraphic imaging with 131J labeled MIBG is a sensitive and highly specific method for localization of pheochromocytoma. In this connection we could demonstrate in 1983 that neuroblastoma can be visualized scintigraphically with MIBG as well. Until now 13 patients were examined with 131J-MIBG by our group: In 10 children with histologically proven neuroblastoma we found a specific enrichment in the tumor area. Besides the primary tumor local recurrence and metastases to bones, bone marrow and brain were detected. There was no neuroblastoma manifestation without MIBG uptake. In 3 patients with tumors other than neuroblastoma no uptake of MIBG was noticed. The results agree with those of other studies: If the physiological pattern of distribution is taken into consideration and if the proper imaging technique is adapted, 131J-MIBG scintigraphy is a highly sensitive and specific method for staging, monitoring of disease and follow-up of neuroblastoma.
The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.
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