Nuclear Medicine Imaging in Neuroblastoma: Current Status and New Developments

Neuroblastoma is the most common extracranial solid malignancy in children. At diagnosis, approximately 50% of patients present with metastatic disease. These patients are at high risk for refractory or recurrent disease, which conveys a very poor prognosis. During the past decades, nuclear medicine has been essential for the staging and response assessment of neuroblastoma. Currently, the standard nuclear imaging technique is meta-[I-123]iodobenzylguanidine ([I-123]mIBG) whole-body scintigraphy, usually combined with single-photon emission computed tomography with computed tomography (SPECT-CT). Nevertheless, 10% of neuroblastomas are mIBG non-avid and [I-123]mIBG imaging has relatively low spatial resolution, resulting in limited sensitivity for smaller lesions. More accurate methods to assess full disease extent are needed in order to optimize treatment strategies. Advances in nuclear medicine have led to the introduction of radiotracers compatible for positron emission tomography (PET) imaging in neuroblastoma, such as [I-124]mIBG, [F-18]mFBG, [F-18]FDG, [Ga-68]Ga-DOTA peptides, [F-18]F-DOPA, and [C-11]mHED. PET has multiple advantages over SPECT, including a superior resolution and whole-body tomographic range. This article reviews the use, characteristics, diagnostic accuracy, advantages, and limitations of current and new tracers for nuclear medicine imaging in neuroblastoma.

Automated summary

Neuroblastoma is a common solid malignancy in children, with a significant portion of patients presenting with metastatic disease and poor prognosis. Nuclear medicine plays a crucial role in staging and response assessment, with PET tracers offering advantages over SPECT in terms of resolution and imaging range. New tracers compatible with PET imaging are being introduced to improve accuracy and optimize treatment strategies for neuroblastoma.