title: Neuroblastoma with a solitary intraventricular brain metastasis visualized on I-123 MIBG scan.
abstract: BACKGROUND
  Although metastatic skull lesions of neuroblastoma are not uncommon, brain involvement is infrequent and prompt diagnosis is of utmost importance in such cases. Previous studies have shown that Meta-Iodo-Benzyl-Guanidine (MIBG) scans were not always reliable in detecting central nervous system metastases, however most published reports referred to the Iodine-131 ((131)I)-MIBG scans. Herein, we report an intraventricular metastasis of neuroblastoma diagnosed using an Iodine-123 ((123)I)-MIBG scan, which is increasingly being used in clinical practice and reported as a more accurate method for detecting metastatic lesions.
  
  
  METHODS
  An unusual case of metastatic neuroblastoma to the left lateral ventricle of the brain is presented. Planar (123)I-MIBG scintigraphy showed faint tracer activity close to the midline without asymmetric extensions or abnormal activity in the skull bones. A subsequent brain MR scan revealed an enhancing mass within the left frontal horn consistent with a metastatic lesion. The patient underwent tumor resection with pathology showing neuroblastoma.
  
  
  CONCLUSIONS
  Our case shows that (123) I-MIBG scintigraphy can be useful in detecting intraventricular brain metastases of neuroblastoma. Although the (123)I-MIBG scintigraphy has been reported to have a significantly superior sensitivity in monitoring asymptomatic patients with neuroblastoma compared with (131)I-MIBG scans, bone marrow histology, bone scan, CT, and urinary catecholamine levels, further studies may be necessary to evaluate its sensitivity in detecting brain lesions.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Ion
authors.initials: I
authors.lastname: Codreanu
authors.forename: Constantin A
authors.initials: CA
authors.lastname: Dasanu
authors.forename: Hongming
authors.initials: H
authors.lastname: Zhuang
mesh_terms: D019797:3-Iodobenzylguanidine; D002551:Cerebral Ventricle Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002648:Child; D006801:Humans; D008297:Male; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
keywords: MIBG scintigraphy; Metastatic neuroblastoma; intraventricular brain metastasis