[18F]mFBG PET-CT for detection and localisation of neuroblastoma: a prospective pilot study

Abstract

Purpose Meta-[18F]fluorobenzylguanidine ([18F]mFBG) is a positron emission tomography (PET) radiotracer that allows for fast and high-resolution imaging of tumours expressing the norepinephrine transporter. This pilot study investigates the feasibility of [18F]mFBG PET-CT for imaging in neuroblastoma. Methods In a prospective, single-centre study, we recruited children with neuroblastoma, referred for meta-[123I]iodobenzylguanidine ([123I]mIBG) scanning, consisting of total body planar scintigraphy in combination with single-photon emission computed tomography-CT (SPECT-CT). Within two weeks of [123I]mIBG scanning, total body PET-CTs were performed at 1 h and 2 h after injection of [18F]mFBG (2 MBq/kg). Detected tumour localisations on scan pairs were compared. Soft tissue disease was quantified by number of lesions and skeletal disease by SIOPEN score. Results Twenty paired [123I]mIBG and [18F]mFBG scans were performed in 14 patients (median age 4.9 years, n = 13 stage 4 disease and n = 1 stage 4S). [18F]mFBG injection was well tolerated and no related adverse events occurred in any of the patients. Mean scan time for [18F]mFBG PET-CT (9.0 min, SD 1.9) was significantly shorter than for [123I]mIBG scanning (84.5 min, SD 10.5), p < 0.01. Most tumour localisations were detected on the 1 h versus 2 h post-injection [18F]mFBG PET-CT. Compared to [123I]mIBG scanning, [18F]mFBG PET-CT detected a higher, equal, and lower number of soft tissue lesions in 40%, 55%, and 5% of scan pairs, respectively, and a higher, equal, and lower SIOPEN score in 55%, 30%, and 15% of scan pairs, respectively. On average, two more soft tissue lesions and a 6-point higher SIOPEN score were detected per patient on [18F]mFBG PET-CT compared to [123I]mIBG scanning. Conclusion Results of this study demonstrate feasibility of [18F]mFBG PET-CT for neuroblastoma imaging. More neuroblastoma localisations were detected on [18F]mFBG PET-CT compared to [123I]mIBG scanning. [18F]mFBG PET-CT shows promise for future staging and response assessment in neuroblastoma. Trial registration Dutch Trial Register NL8152.

Something old has become new: PET imaging of neural-crest tumors with [18F]-meta-fluorobenzylguanidine

“…No changes were made patients with respect to [ 123 I]-mIBG, thanks to the shorter duration of the scan (Fig. 1) [11][12][13]. It is worth mentioning that, as reported in the previously cited papers [9,11], [ 18 F]-mFBG PET/CT significantly impacted on the calculation of SIOPEN score, providing a higher value than that calculated on [ 123 I]-mIBG scintigraphy.…”

“…1) [11][12][13]. It is worth mentioning that, as reported in the previously cited papers [9,11], [ 18 F]-mFBG PET/CT significantly impacted on the calculation of SIOPEN score, providing a higher value than that calculated on [ 123 I]-mIBG scintigraphy. However, if and how much mFBG-based calculation might impact on the prognostic value of SIOPEN score in clinical practice is still unclear and will be topic of future investigations.…”

“…In a recently published prospective cross-sectional study, twenty patients affected by NB, submitted to [ 123 I]-mIBG scintigraphy as a part of their standard diagnostic work-up, also underwent [ 18 F]-mFBG PET/CT within an interval of 2 weeks before or after [ 123 I]-mIBG scan [11]. After the administration of [ 18 F]-mFBG (i.e., 2 MBq/Kg), PET/CT was acquired at 1 and 2 h to determine the optimal timepoint for image acquisition.…”

[18F]mFBG long axial field of view PET-CT without general anaesthesia reveals concise extension of neuroblastoma in a 9-month-old boy

“…Hence, standard diagnostics with MRI and [ 123 I] mIBG-scintigraphy was not feasible [1]. Instead, the tumour extension was assessed with [ 18 F]mFBG long axial field of view(LAFOV)-PET/CT (106 cm) without GA/sedation [2,3], acquired 62 min p.i. of 30 MBq (3 MBq/kg) [4].…”

The Pitfall of Ganglioneuroblastoma-Nodular Diagnosis: Clinical and Imaging Considerations over a Rare Bifocal Sporadic Case

“…There is a correlation between 18 F-FDG PET findings and disease status of NB which found that 18 F-FDG PET uptake is directly proportional to tumor burden and tumor cell proliferation; therefore, higher values of SUVmax suggest the presence of a NT with unfavorable biological characteristics and worse prognosis [ 17 ]. Recently, meta-18F-fluorobenzylguanidine ( 18 F-mFBG) showed promise for future staging and response assessment in NBL, allowing for fast and high-resolution imaging of tumors expressing the norepinephrine transporter [ 18 ]. Regarding MRI, reliability of DWI in the differential diagnosis of malignant and benign NT is much discussed and it was observed that lower ADC values are more characteristic of NB/GNBN than GNBI/GNs [ 14 ].…”