Integrated Imaging Using MRI and ¹²³| Metaiodobenzylguanidine Scintigraphy to Improve Sensitivity and Specificity in the Diagnosis of Pediatric Neuroblastoma

Abstract

In the assessment of neuroblastoma lesions in pediatric patients, MRI showed a higher sensitivity and MIBG scintigraphy a higher specificity. However, integrated imaging showed an increase in both sensitivity and specificity.

Tumors of the Adrenal Gland

“…Although results of MIBG scan correlate fairly well with bone marrow aspirates and MRI, MIBG cannot replace marrow aspirates at diagnosis and evaluation of response in children with neuroblastoma. The combined use of 123 I-MIBG scintigraphy and MRI has been shown to increase the sensitivity and specifi city of the diagnosis of neuroblastoma [ 52 ]. Poor prognosis has been associated with MIBG-avid tumors in stage IV patients over 1 year of age at presentation and in those patients that remain avid after chemotherapy.…”

Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

“…In mIBG-negative tumours, the use of somatostatin receptor scintigraphy may be considered in selected individual patients, although uptake of 111 In-pentetreotide is more common in favourable prognosis neuroblastoma (Schilling et al, 2000). Whole body MRI is also a sensitive test for neuroblastoma tumours, including bone and bone marrow metastases, although the specificity is much lower than mIBG (Pfluger et al, 2003). Further prospective and comparative studies will be needed to assess the relative merits of these methods.…”

“…A recent study using blinded readers and concomitant pathology, CT scan and clinical information showed that 123 I-mIBG scintigraphy had a sensitivity of 88% and a specificity of 83% (Vik et al, 2009). Occasionally, false-positive readings may occur because of uptake in mature ganglioneuroma or other neuroendocrine tumours, or because of physiological uptake that may be mistaken for tumour in the adrenal gland, salivary gland, nasopharynx, brown fat or excretion through renal pelvis and bladder (Pfluger et al, 2003). False-negative scans may be observed in approximately 10% of neuroblastomas that do not concentrate mIBG, owing to low expression of the norepinephrine transporter (Carlin et al, 2003), or owing to blood -brain barrier or large areas of scar or necrosis (Matthay et al, 2003a).…”

The ALARA concept in pediatric oncology

“…Several studies suggest that neuroblastoma staging and response assessment may be effectively accomplished with MIBG scintigraphy coupled with whole-body MRI and/or CT [27], although an increasing role for FDG-PET in neuroblastoma has also been reported [28]. There are few instances (with the notable exception of stage IV-S disease) where disease is detected only by bone scintigraphy but is not seen by MIBG and/or CT/MRI [29].…”