<sup>123</sup>I‐<i>m</i>IBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial

Vik, Terry A.; Pfluger, Thomas; Kadota, Richard; Castel, Victoria; Tülchinsky, Mark; Farto, J.C. Alonso; Heiba, Sherif; Serafini, Aldo N.; Tumeh, Sabah S.; Khutoryansky, Naum; Jacobson, Arnold F.

doi:10.1002/pbc.21932

Cited by 112 publications

(63 citation statements)

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“…In the past several years, many radiopharmaceuticals, including metaiodobenzylguanidine (MIBG), that were formerly labeled with 131 I are now labeled with 123 I because it has better dosimetric and imaging properties (1)(2)(3). 123 I decays by electron capture, with a 13.2-h half-life.…”

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confidence: 99%

Improved Quality of Pediatric 123I-MIBG Images with Medium-Energy Collimators

Snay

Treves²,

Fahey³

2011

Journal of Nuclear Medicine Technology

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Our objective was to optimize the quality of 123 I-metaiodobenzylguanidine (MIBG) scans by using a medium-energy collimator to reduce high-energy-photon septal penetration. Methods: In addition to the 159-keV g-ray, 123 I has a small abundance of energies above 400 keV that can compromise the image quality of MIBG studies because of septal penetration. Using a lowenergy ultrahigh-resolution collimator (LEUHR), a low-energy high-resolution collimator (LEHR), and a medium-energy collimator, we obtained and compared SPECT and planar images of a SPECT phantom filled with 123 I. These studies were acquired at a count level comparable to clinical MIBG images, 24,000 counts per view for SPECT and 300,000 counts for planar imaging. Also, we evaluated the sensitivity of the 3 collimators at 0 and 10 cm using the National Electrical Manufacturers Association protocol. Results: The image quality for both SPECT and planar 123 I images using the medium-energy collimator was determined to be substantially better than that using the LEUHR or LEHR collimator. The septa of the medium-energy collimator are thicker than those of the low-energy collimators (1.14 vs. 0.13-0.16 mm), leading to a significant reduction in septal penetration of the high-energy g-rays and a marked improvement in image quality. The sensitivity for the medium-energy collimator did not change with distance (8.00 cpm/kBq), as opposed to the LEUHR collimator (6.59 and 5.51 cpm/kBq for 0 and 10 cm, respectively) and the LEHR collimator (14.32 and 12.30 cpm/kBq for 0 and 10 cm, respectively). This variation in sensitivity for the LEUHR collimator is again due to the presence of high-energy photons. Conclusion: Use of a medium-energy collimator substantially improves the quality of both planar and SPECT 123 I images. We recommend that a medium-energy collimator routinely be used for 123 I-MIBG imaging. In the past several years, many radiopharmaceuticals, including metaiodobenzylguanidine (MIBG), that were formerly labeled with 131 I are now labeled with 123 I because it has better dosimetric and imaging properties (1-3). 123 I decays by electron capture, with a 13.2-h half-life. The primary g-ray of its daughter, 123 Te, has an energy of 159 keV. In addition to the 159-keV g-ray (83.3% abundance), several other g-rays of higher energy and low abundance are also emitted as a result of the decay of 123 I. Several of these emissions are summarized in Table 1 (4). g-rays with energies greater than 400 keV are emitted 2.73% of the time, and g-rays with energies greater than 600 keV are emitted 0.23% of the time. The average energy of the higher-energy g-rays is 507 keV. Although these highenergy g-rays are in low abundance, the low-energy collimators traditionally used for 123 I-MIBG imaging are not effective in stopping them. The result-substantial septal penetration (i.e., the fraction of g-rays that cross the septa separating the collimator holes)-can, in turn, lead to a loss of contrast and image quality. Figure 1 shows a cross section of a parallel-hole collim...

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confidence: 99%

Improved Quality of Pediatric 123I-MIBG Images with Medium-Energy Collimators

Snay

Treves²,

Fahey³

2011

Journal of Nuclear Medicine Technology

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“…In non-paediatric institutions, because of the longer time required for young children with additional sedation, and increased expense, they may not be regularly obtained. In the study by Vik et al (2009), SPECT views only marginally increased the sensitivity from 88 to 91%. Although additional information was gained in 65% of cases regarding the precise anatomic location of uptake, Curie scores would not have been substantially altered.…”

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confidence: 74%

“…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).…”

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

et al. 2010

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BACKGROUND: Neuroblastoma is an embryonic tumour of the sympathetic nervous system, metastatic in half of the patients at diagnosis, with a high preponderance of osteomedullary disease, making accurate evaluation of metastatic sites and response to therapy challenging. Metaiodobenzylguanidine (mIBG), taken into cells via the norepinephrine transporter, provides a sensitive and specific method of assessing tumour in both soft tissue and bone sites. The goal of this report was to develop consensus guidelines for the use of mIBG scans in staging, response assessment and surveillance in neuroblastoma. METHODS: The International Neuroblastoma Risk Group (INRG) Task Force, including a multidisciplinary group in paediatric oncology of North and South America, Europe, Oceania and Asia, formed a subcommittee on metastatic disease evaluation, including expert nuclear medicine physicians and oncologists, who developed these guidelines based on their experience and the medical literature, with approval by the larger INRG Task Force. RESULTS: Guidelines for patient preparation, radiotracer administration, techniques of scanning including timing, energy, specific views, and use of single photon emission computed tomography are included. Optimal timing of scans in relation to therapy and for surveillance is reviewed. Validated semi-quantitative scoring methods in current use are reviewed, with recommendations for use in prognosis and response evaluation. CONCLUSIONS: Metaiodobenzylguanidine scans are the most sensitive and specific method of staging and response evaluation in neuroblastoma, particularly when used with a semi-quantitative scoring method. Use of the optimal techniques for mIBG in staging and response, including a semi-quantitative score, is essential for evaluation of the efficacy of new therapy.

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“…MIBG, an analog of norepinephrine and a guanethidine derivative, is taken up and stored in NB cells expressing the norepinephrine transporter and is radio-iodinated for imaging use (Boubaker & Bischof Delaloye, 2008). MIBG scan has a reported sensitivity and specificity of 88% and 83%, respectively (Vik et al, 2009). In comparison, 99m Tc-technetium bone scan is reported to have a sensitivity of 75% and specificity of 50% for the detection of skeletal metastases (Jacobs et al, 1990).…”

Section: Metastatic Diseasementioning

confidence: 99%

Recurrent Neuroblastoma

M.S.¹,

Wendy²

2012

Neuroblastoma - Present and Future

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¹²³I‐mIBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial

Abstract: This prospective multicenter trial of (123)I-mIBG scintigraphy documents high sensitivity and specificity of this imaging technique in patients with both newly diagnosed and previously treated neuroblastoma.

Cited by 112 publications

References 21 publications

Improved Quality of Pediatric 123I-MIBG Images with Medium-Energy Collimators

Improved Quality of Pediatric 123I-MIBG Images with Medium-Energy Collimators

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

Recurrent Neuroblastoma

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123I‐mIBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial

Abstract: This prospective multicenter trial of (123)I-mIBG scintigraphy documents high sensitivity and specificity of this imaging technique in patients with both newly diagnosed and previously treated neuroblastoma.

Cited by 112 publications

References 21 publications

Improved Quality of Pediatric 123I-MIBG Images with Medium-Energy Collimators

Improved Quality of Pediatric 123I-MIBG Images with Medium-Energy Collimators

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

Recurrent Neuroblastoma

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¹²³I‐mIBG scintigraphy in patients with known or suspected neuroblastoma: Results from a prospective multicenter trial