131I/123I-Metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imaging

Bombardieri, Emilio; Aktolun, Cumali; Baüm, Richard; Bishof-Delaloye, Angelika; Buscombe, J. R.; Chatal, Jean François; Maffioli, Lorenzo; Moncayo, Roy; Mortelmans, Luc; Reske, Sven N.

doi:10.1007/s00259-010-1545-7

Cited by 229 publications

(122 citation statements)

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“…131 /I 123 MIBG has been used for the last two decades to image neuroendocrine tumors [89] because uptake reflects adrenergic innervation or catecholamine excretion. MIBG scintigraphy has a sensitivity and specificity of 94% (95% CI: 91%-97%) and 92% (95% CI: 87%-98%), respectively [90].…”

Section: Metaiodobenzylguanidine Scintigraphymentioning

confidence: 99%

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

et al. 2013

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Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare catecholamine-secreting tumors derived from chromaffin cells originating in the neural crest. These tumors represent a significant diagnostic and therapeutic challenge because the diagnosis of malignancy is frequently made in retrospect by the development of metastatic or recurrent disease. Complete surgical resection offers the only potential for cure; however, recurrence can occur even after apparently successful resection of the primary tumor. The prognosis for malignant disease is poor because traditional treatment modalities have been limited. The last decade has witnessed exciting discoveries in the study of PCCs and PGLs; advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors, and increasing knowledge of genotype-phenotype interactions has facilitated more accurate determination of malignant potential. Elucidating the molecular mechanisms responsible for malignant transformation in these tumors has opened avenues of investigation into targeted therapeutics that show promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for PCC. In this review, we discuss the currently available diagnostic and therapeutic options for patients with malignant PCCs and PGLs and detail the molecular rationale and clinical evidence for novel and emerging diagnostic and therapeutic strategies. TheOncologist2013; 18:391-407 Implications for Practice: Malignant pheochromocytoma and paraganglioma represent a significant management challenge.The diagnosis of malignancy is frequently made in retrospect and traditional treatment modalities have been limited. Recent exciting advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors. Increasing knowledge of genotype-phenotype interactions facilitates more accurate determination of malignant potential and has prompted investigation into targeted therapeutics with promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for pheochromocytoma. Due to the rarity of this tumor, large-scale clinical studies that would progress clinical practice are rare, and the requirement for international collaboration is crucial. The need for large-scale international multicenter studies to effectively exploit the molecular and genetic knowledge gained in this area is highlighted in this review.

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Section: Metaiodobenzylguanidine Scintigraphymentioning

confidence: 99%

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

et al. 2013

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“…The quality of the images has to be diagnostically excellent in pediatric nuclear medicine but superfluous scans must be avoided and doses must be as low as reasonably achievable and adjusted to each child according to international recommendations [7,[13][14][15][16]. These goals can be more easily reached in dedicated pediatric facilities.…”

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confidence: 99%

“…The best option for the future in pediatric oncology, however, is PET/MR. In bone scintigraphy or an MIBG scan, performance of an SPECT/CT scan significantly increases the radiation dose [15][16][17]. A possibility is to use a lower-dose nondiagnostic CT scan in these cases.…”

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confidence: 99%

Pediatric nuclear medicine and pediatric radiology

Bielsa

Vlajković

2013

Pediatr Radiol

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To improve clinical practice is our daily duty as specialists in radiology and in nuclear medicine. When a clinician asks us to perform an imaging examination, we have to advise that clinician about the best test or imaging strategy to study the clinical problem. Risk-to-benefit ratio and the ALARA principle have to be weighed, as well as modality and cost.Hybrid imaging is now the standard in nuclear medicine. The use of multimodality cameras such as SPECT/CT, PET/CT and PET/MR has been revolutionary [1][2][3][4]. The key is finding the exact location of functional or metabolic lesions. But adding CT increases the dosimetry [5][6][7], requires more detailed knowledge of imaging anatomy and depends on collaboration between radiologists and nuclear medicine specialists. The level of expertise among imaging specialists (at least in pediatric nuclear medicine) varies too much. In some countries nuclear medicine is an independent specialty, and in other countries radiologists are in charge of nuclear medicine tests. Physicians-in-training in radiology and in nuclear medicine have to receive multimodality training [8][9][10][11][12]. And continuing education in both specialties is vital to ensure that senior specialists are well-versed in the latest techniques. In any case, imaging specialists must be able to discuss the options with referring clinicians and to advise them on the appropriate technique for each clinical situation.Pediatric nuclear medicine can be performed in general nuclear medicine facilities or in dedicated pediatric nuclear medicine departments. The quality of the images has to be diagnostically excellent in pediatric nuclear medicine but superfluous scans must be avoided and doses must be as low as reasonably achievable and adjusted to each child according to international recommendations [7,[13][14][15][16]. These goals can be more easily reached in dedicated pediatric facilities.Dose reduction remains important. Contrary to general opinion the radiation dose of most nuclear medicine scans is lower than that of many comparable radiologic studies. The most typical example is abdominal CT, which has a higher dose than the most frequent nuclear medicine studies. Another example is that two-thirds of the radiation dose from PET/CT is from the CT component [12][13][14]. In the latter case it is possible to perform a diagnostic CT scan during the PET/CT examination rather than a separate diagnostic CT scan. Or a lower-dose CT scan could be performed in a patient who has recently undergone a diagnostic CT scan. The best option for the future in pediatric oncology, however, is PET/MR. In bone scintigraphy or an MIBG scan, performance of an SPECT/CT scan significantly increases the radiation dose [15][16][17]. A possibility is to use a lower-dose nondiagnostic CT scan in these cases. And the best practice is to report together with the radiologist, comparing the SPECT and the CT or MR images frame-by-frame.In many papers, correlative analysis of PET/CT images in children has been reported to be superior ...

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“…The cohort was small (n = 31), and the majority (87%) had BP controlled with medications: 58% were on beta blockers; 45% were on calcium antagonists, and 71% were on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. A variety of medications, including the classes of antihypertensive drugs, e.g., calcium antagonists 18 and beta blockers 18,26 that were taken by participants in the Takamura et al study, are known to interfere with mIBG imaging. It is recommended that these medications be discontinued 24-72 h prior to radiotracer injection, creating safety concerns for patients with resistant hypertension, a population that would be likely candidates for the renal denervation procedure were it to be incorporated into clinical practice.…”

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confidence: 99%

“…17 The timing of mIBG uptake is tissue-specific. 15 Most cardiac 123 I-mIBG studies image early and late uptake at approximately 15 min and 3-4 h after injection, respectively, whereas oncologic studies typically image at roughly 24 h. 18 Washout rate is determined as the rate of decrease in myocardial uptake between early and delayed imaging and reflects sympathetic activity and tone. In the heart, a high washout rate indicates increased sympathetic activity, 16 and unlike uptake, is independent of the number of neurons in the tissue.…”

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confidence: 99%

123I-mIBG scintigraphy: Clinical tool for assessing renal sympathetic activity?

George

Bhambhvani

Oparil

2017

Journal of Nuclear Cardiology

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See related article, pp. 363-371Among patients with treatment-resistant hypertension, transcatheter renal denervation has been shown to reduce blood pressure (BP) in a number of uncontrolled, unblinded clinical trials.1 However, in a prospective, single-blind, randomized trial that compared transcatheter renal denervation to a sham procedure, there was no significant difference in systolic BP between the two treatment arms at 6 months follow-up.2 Proposed reasons for the lack of benefit include a substantial placebo effect related to the procedure, differences in medication adherence such that the sham-treated control group may have taken more antihypertensive medications, operator inexperience with transcatheter renal denervation, and performance of an inadequate number of ablations in each renal artery.3 It has been postulated that operator inexperience and performance of too few ablations may have led to incomplete denervation and therefore an inadequate BP response to the procedure. The absence of a readily available methodology to define completeness of transcatheter renal denervation in humans remains as an unmet need in defining the potential role of the procedure in clinical practice.The contribution of increased renal sympathetic tone to the pathophysiology of hypertension has been known for decades. Surgical renal denervation in hypertensive animal models has been shown to cause significant decreases in BP compared to sham controls. 4 A commonly employed method of surgical denervation involves stripping the adventitia from the renal artery of hypertensive rats and exposing the artery to phenol, a compound that irreversibly blocks neural conduction. 5Renal norepinephrine (NE) content measured at specified time points after surgical denervation in hypertensive rats has been shown to decrease dramatically (94% reduction compared to sham-controlled rats at 1 week; P \ 0.001), suggesting complete ablation of the renal nerves. A positive correlation was also shown between absolute change in BP after denervation and renal NE content in denervated animals (r = 0.80, P \ 0.001). 4In the clinical research setting, a number of methods have been utilized to assess the completeness of renal denervation in hypertensive humans. The most promising and best characterized are the measurements of muscle sympathetic nerve activity (MSNA), renal NE spillover rate, and assessment of sympathetically mediated responses to electrical stimulation of the renal artery before and after denervation.6-8 Assessment of MSNA is minimally invasive and entails percutaneous insertion of a recording electrode into a superficial nerve (peroneal or radial), allowing direct recording of postganglionic sympathetic neural bursts. MSNA reflects moment-to-moment sympathetic outflow from the central nervous system to either skeletal muscle or skin, but does not provide direct information on sympathetic outflow to the kidney or heart. 9Renal NE spillover is assessed by infusing small doses of radiolabeled NE intravenously and measuring its level in...

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131I/123I-Metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imaging

Cited by 229 publications

References 24 publications

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

Pediatric nuclear medicine and pediatric radiology

123I-mIBG scintigraphy: Clinical tool for assessing renal sympathetic activity?

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