Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical experience with $^{18}F$-fluorodeoxyglucose positron emission tomography and $^{123}I$-metaiodobenzylguanine scintigraphy in pediatric neuroblastoma: complementary roles in follow-up of patients

  • Gil, Tae Young (Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine) ;
  • Lee, Do Kyung (Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine) ;
  • Lee, Jung Min (Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine) ;
  • Yoo, Eun Sun (Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine) ;
  • Ryu, Kyung-Ha (Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine)
  • Received : 2014.03.14
  • Accepted : 2014.05.16
  • Published : 2014.06.10
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Abstract

Purpose: To evaluate the potential utility of $^{123}I$-metaiodobenzylguanine ($^{123}I$-MIBG) scintigraphy and $^{18}F$-fluorodeoxyglucose ($^{18}F$-FDG) positron emission tomography (PET) for the detection of primary and metastatic lesions in pediatric neuroblastoma (NBL) patients, and to determine whether $^{18}F$-FDG PET is as beneficial as $^{123}I$-MIBG imaging. Methods: We selected 8 NBL patients with significant residual mass after operation and who had paired $^{123}I$-MIBG and $^{18}F$-FDG PET images that were obtained during the follow-up. We retrospectively reviewed the clinical charts and the findings of 45 paired scans. Results: Both scans correlated relatively well with the disease status as determined by standard imaging modalities during follow-up; the overall concordance rates were 32/45 (71.1%) for primary tumor sites and 33/45 (73.3%) for bone-bone marrow (BM) metastatic sites. In detecting primary tumor sites, $^{123}I$-MIBG might be superior to $^{18}F$-FDG PET. The sensitivity of $^{123}I$-MIBG and $^{18}F$-FDG PET were 96.7% and 70.9%, respectively, and their specificity were 85.7% and 92.8%, respectively. $^{18}F$-FDG PET failed to detect 9 true NBL lesions in 45 follow-up scans (false negative rate, 29%) with positive $^{123}I$-MIBG. For bone-BM metastatic sites, the sensitivity of $^{123}I$-MIBG and $^{18}F$-FDG PET were 72.7% and 81.8%, respectively, and the specificity were 79.1% and 100%, respectively. $^{123}I$-MIBG scan showed higher false positivity (20.8%) than $^{18}F$-FDG PET (0%). Conclusion: $^{123}I$-MIBG is superior for delineating primary tumor sites, and $^{18}F$-FDG PET could aid in discriminating inconclusive findings on bony metastatic NBL. Both scans can be complementarily used to clearly determine discrepancies or inconclusive findings on primary or bone-BM metastatic NBL during follow-up.

Keywords

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