Originally published as JCO Early Release 10.1200/JCO.2008.20.5732 on October 5 2009

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Comparison of Iodine-123 Metaiodobenzylguanidine (MIBG) Scan and [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography to Evaluate Response After Iodine-131 MIBG Therapy for Relapsed Neuroblastoma

From the Department of Pediatrics and Nuclear Medicine, University of California, San Francisco; Departments of Biostatistics, Pediatrics, and Radiology, University of Southern California, Los Angeles, CA; and Department of Pediatrics, University of Pennsylvania, Philadelphia, PA.

Corresponding author: Katherine Matthay, MD, Department of Pediatrics, UCSF School of Medicine, 505 Parnassus Ave, Box 0106, San Francisco, CA 94143-0106; e-mail: matthayk{at}peds.ucsf.edu.

Purpose Children with relapsed neuroblastoma have poor survival. It is crucial to have a reliable method for evaluating functional response to new therapies. In this study, we compared two functional imaging modalities for neuroblastoma: metaiodobenzylguanidine (MIBG) scan for uptake by the norepinephrine transporter and [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) uptake for glucose metabolic activity.

Patients and Methods Patients enrolled onto a phase I study of sequential infusion of iodine-131 (¹³¹I) MIBG (NANT-2000-01) were eligible for inclusion if they had concomitant FDG-PET and MIBG scans. ¹³¹I-MIBG therapy was administered on days 0 and 14. For each patient, we compared all lesions identified on concomitant FDG-PET and MIBG scans and gave scans a semiquantitative score.

Results The overall concordance of positive lesions on concomitant MIBG and FDG-PET scans was 39.6% when examining the 139 unique anatomic lesions. MIBG imaging was significantly more sensitive than FDG-PET overall and for the detection of bone lesions (P < .001). There was a trend for increased sensitivity of FDG-PET for detection of soft tissue lesions. Both modalities showed similar improvement in number of lesions identified from day 0 to day 56 scan and in semiquantitative scores that correlated with overall response. FDG-PET scans became completely negative more often than MIBG scans after treatment.

Conclusion MIBG scan is significantly more sensitive for individual lesion detection in relapsed neuroblastoma than FDG-PET, though FDG-PET can sometimes play a complementary role, particularly in soft tissue lesions. Complete response by FDG-PET metabolic evaluation did not always correlate with complete response by MIBG uptake.

Supported in part by National Institutes of Health (NIH) Grants No. NCI T32 CA128583-01, NCI R21 CA97758, NCI PO1 81403, and NCRR UCSF-CTSI UL1 RR024131, and the Dougherty Foundation, Alex Lemonade Foundation, Campini Foundation, V-Foundation, Mildred V. Strouss Chair, and Conner Fund.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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