Neuroblastoma: imaging evaluation by sequential Tc-99m MDP, I-131 MIBG, and Ga-67 citrate studies.
Fourteen children with histopathologically confirmed neuroblastoma underwent sequential correlative imaging studies using I-131 MIBG, Tc-99m MDP, and Ga-67 citrate during various stages of the disease. Of the patients 86% showed I-131 MIBG accumulation in the primary tumoral site, whereas 71% showed Tc-99m MDP and 79% Ga-67 citrate uptake. In 86% at least one of the two latter radiopharmaceuticals concentrated in the primary tumor. The use of all three radiopharmaceuticals raised the detection rate to 93%. Of the osseous or extraosseous metastases 100% were detected by Tc-99m MDP studies. The I-131 MIBG studies were positive in 71% of the osseous metastases and in 70% of the extraosseous metastases. No Ga-67 citrate uptake was demonstrated in osseous metastases, although one extraosseous lung metastasis concentrated this radiopharmaceutical. Tc-99m MDP bone imaging was the best method for diagnosing metastatic spread of the disease and for monitoring the results of treatment. Primary tumor uptake was best indicated by I-131 MIBG. Both Ga-67 citrate and I-131 MIBG were superior to Tc-99m MDP with regard to accurately demonstrating the extent of primary tumors. Only Tc-99m MDP indicated the relationship of these tumors to the kidneys and neighboring osseous structures, providing early screening of kidney compression. Ga-67 citrate study was mainly indicated in tumors with catecholamine depletion, which failed to concentrate the other two radiopharmaceuticals. I-131 MIBG proved especially useful in detecting neuroblastoma with negative Tc-99m MDP and Ga-67 citrate studies and also proved to be helpful with those cases in which I-131 MIBG was planned for therapy. The following strategy is suggested for evaluating neuroblastoma.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Nuclear Medicine, Central Emek Hospital, Afula, Israel.
I
I
Garty
A
A
Friedman
M P
MP
Sandler
A
A
Kedar
D019797:3-Iodobenzylguanidine; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D002951:Citrates; D019343:Citric Acid; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000556:secondary; D011877:Radionuclide Imaging; D013669:Technetium Tc 99m Medronate
D002951:Citrates; D005710:Gallium Radioisotopes; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D019343:Citric Acid; D019797:3-Iodobenzylguanidine; D013669:Technetium Tc 99m Medronate