PET/CT and MIBG scans in diagnosis and management of Neuroblastoma

Abstract

Introduction and aim: Several studies report conflicting results about 18 F-FDG/PET and MIBG scans and their diagnostic as well as prognostic significance in children with neuroblastoma. The current study was meant to evaluate both modalities and to compare them in relation to standardized modes of evaluation. Results: FDG/PET showed good results in detecting NB at all sites. FDG/PET also showed a higher sensitivity and specificity, and a better PPV/NPV than MIBG which was not statistically significant. Concordance between paired scans (MIBG, and PET) was found in 55.7% of cases (Kappa=0.001) for primary tumor site, and in 7% for bone and 19.4% for bone marrow. The significance of concordance between both modalities was only demonstrated for metastatic boney lesions. There were 13 patients having stage III neuroblastoma (43.3%) while 17 patients (56.7%) were having stage IV disease. 23 Patients were categorized as high risk (76.7%) while 7 patients (23.3%) were intermediate risk. Both, PET/CT scan and MIBG were more sensitive in detecting disease at stage IV than stage III. Patients and Conclusion:18 F-FDG/PET scan can be used effectively in both diagnosis and management decisions for children with neuroblastoma, it is a good complementary tool especially in detecting bone metastasis, although further clinical trials must agree on definite analytical aspects between both modalities.

Diagnostic Performance of 18F-FDG PET(CT) in Bone-Bone Marrow Involvement in Pediatric Neuroblastoma: A Systemic Review and Meta-Analysis

“…Kushner and colleagues found that PET was equal to 123 I/ 131 I MIBG scans in detecting NB when including the skull in the comparison, but was superior in only extracranial skeletal structures [17]. Additionally, Fawzy et al suggested overall accuracy of 18 F-FDG PET/CT was slightly higher than MIBG in the detection of BMI with values of 66.6% and 66.3% [11]. In contrast, several studies showed that 123 I-MIBG scan was more sensitive in assessment of bony metastatic lesions than 18 F-FDG PET [28,29].…”

“…ere were two studies evaluating the usefulness of FDG PET, with regard to detection of bone/BMI in pediatric NB patients. Moreover, one of the two studies focused on Fawzy et al [11] Gil et al [12] Ishiguchi et al [13] Tezol et al [14] Yagci-Kupeli et al [15] Zapata et al [16] Patient pretreatment patients, which reduced the number of false positives. Since it has been known that chemotherapy can stimulate hyperactivity in bone marrow, subgroup analysis performed by two different analysis types suggested that patient-based analysis showed a lower sensitivity but a higher specificity than those of lesion-based analysis.…”

“…Previous meta-analysis suggested that 18 F-FDG PET had a higher sensitivity but lower specificity than MIBG scintigraphy in NB lesion detection [8]. Another recent meta-analysis reported a 17% pooled sensitivity of positron emission tomography (computed tomography) (PET(CT)) for the detection of bone marrow in pediatric NB in their subgroup analysis, which was significantly lower than several studies [9][10][11][12][13][14][15][16]. Superiorities of PET are high 18 F-FDG avidity of the bone marrow and imaging of the entire marrow [17].…”

“…en, 16 full-text articles were selected to read carefully, and 7 studies comprising a total of 127 patients were enrolled in the current meta-analysis finally [10][11][12][13][14][15][16]. A flow diagram of eligible literature is shown in Figure 1.…”

“…All studies [10][11][12][13][14][15][16] revealed an unclear risk in reference standard, owing to lack of information with regards to histological results without prior clinical and imaging data. 3 studies [14][15][16] revealed a high risk in flow and timing since not all of the patients were included in this meta-analysis.…”