technetium-tc-99m-medronate and Neuroblastoma

Neuroblastoma is the third most common malignant solid tumor of childhood. It originates from primitive neural crest cells of the sympathetic nervous system. Many imaging procedures help guide therapy and predict outcomes. Anatomic imaging methods, such as CT and MRI, are most useful for evaluation of the primary tumor mass and nearby involved lymph nodes. Functional imaging tracers, such as [123I]MIBG, [18F]FDG, and [99mTc]MDP, are used to assess the extent of disease and to search for distant metastases. [123I]MIBG is the principal functional imaging tracer for the detection and monitoring of neuroblastoma. [18F]FDG PET/CT is an alternative that is valuable in tumors with poor or no MIBG-uptake. [99mTc]MDP bone scans may be useful to assess cortical bone metastases. This article will review the use of [123I]MIBG and other functional imaging agents for the management of patients with neuroblastoma.

Topics: 3-Iodobenzylguanidine; Central Nervous System Neoplasms; Child; Child, Preschool; Diagnostic Imaging; Female; Fluorodeoxyglucose F18; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Medical Oncology; Neuroblastoma; Prognosis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

In this study, we investigated prospectively the diagnostic role of 99Tcm-MIBI for staging and for predicting the therapeutic response of stage IV neuroblastoma compared with 131I-MIBG imaging and 99Tcm-MDP bone scintigraphy. Nine patients (4 girls and 5 boys aged 1-7 years) with suspected or proven stage IV neuroblastoma were studied with 99Tcm-MIBI at initial diagnosis and after 12-18 months of multidrug therapy. After the injection of 80 MBq.kg-1 99Tcm-MIBI, early (10 min) and delayed (1 h) images were obtained. The data were correlated with 131I-MIBG scans, bone scintigraphy, ultrasound, computed tomography and/or magnetic resonance imaging, and bone marrow biopsy. Eight of nine primary tumours and 41 metastatic lesions were detected by 131I-MIBG scintigraphy. None of the primary lesions demonstrated significant 99Tcm-MIBI accumulation. Sestamibi was positive in 16 of 41 MIBG-avid metastatic lesions. After six courses of multidrug chemotherapy, 30 131I-MIBI-avid neuroblastoma metastases that were 99Tcm-MIBI-negative at the time of diagnosis still did not show significant sestamibi accumulation. Follow-up demonstrated that all lesions that were 99Tcm-MIBI-avid at the time of diagnosis remained negative. Of these 16 lesions, seven were positive for 131I-MIBG accumulation with no reduction in size, and nine showed resolution after therapy. New metastatic foci detected by MIBG scintigraphy did not accumulate 99Tcm-MIBI. Clinical evaluation of patients with no 99Tcm-MIBI uptake in primary and secondary sites of neuroblastoma confirmed that they were resistant to multidrug chemotherapy. All 99Tcm-MIBI-positive lesions, irrespective of clinical outcome, demonstrated significant clearance of tracer on the delayed images. We conclude that 99Tcm-MIBI has no role in the staging of neuroblastoma. Sestamibi is a well-documented transport substrate for P-glycoprotein-related multidrug resistance and serial imaging may provide prognostic information on the therapeutic value of chemotherapy.

Topics: 3-Iodobenzylguanidine; Brain Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Neoplasm Staging; Neuroblastoma; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole-Body Counting

Topics: Bone and Bones; Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Neuroblastoma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Accurate staging of neuroblastoma requires multiple imaging examinations. The purpose of this study was to determine the relative contribution of. A medical record search by the identified patients with neuroblastoma from 1993 to 2012 who underwent both MIBG and bone scan for disease staging. Cross-sectional imaging was used to corroborate the scintigraphy results. Clinical records were used to correlate imaging findings with clinical staging and patient management.. One hundred thirty-two patients underwent both MIBG and bone scan for diagnosis. All stage 1 (n = 12), 2 (n = 8), and 4S (n = 4) patients had a normal bone scan with no skeletal MIBG uptake. Six of 30 stage 3 patients had false (+) bone scans. In the 78 stage 4 patients, 58/78 (74%) were both skeletal MIBG(+)/bone scan (+). In 56 of the 58 cases, skeletal involvement detected with MIBG was equal to or greater than that detected by bone scan. Only 3/78 had (-) skeletal MIBG uptake and (+) bone scans; all 3 had other sites of metastatic disease. Five of 78 had (+) skeletal MIBG with a (-) bone scan, while 12/78 had no skeletal involvement by either MIBG or bone scan. In no case did a positive bone scan alone determine a stage 4 designation.. In the staging of neuroblastoma,

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Cohort Studies; Contrast Media; Cross-Sectional Studies; Follow-Up Studies; Humans; Iodine Radioisotopes; Neoplasm Staging; Neuroblastoma; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We report an unusual case of primary neuroblastoma in an 11-year-old girl. The superior portion of the tumor accumulated I-MIBG, Tc-MDP, and F-FDG. In contrast, the inferior portion of the tumor showed no abnormal F-FDG or Tc-MDP uptake, which usually indicates tumor necrosis. This inferior portion of the tumor, however, had intense I-MIBG activity, consistent with viable tumor rather than tumor necrosis.

Topics: 3-Iodobenzylguanidine; Biological Transport; Child; Female; Fluorodeoxyglucose F18; Humans; Neuroblastoma; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Neuroblastoma is a common childhood neoplasia arising from neurogenic tissues. Main symptoms of this disease are bone pain, fewer, weight loss and anaemia. I-131 metaiodobenzylguanidine (MIBG) is a highly sensitive and specific method in the detection of this disease and method of choice in staging, treatment response and recurrence detection as well as prognostification. In determination of the bone metastasis Tc-99m methylenediphosphonate (MDP) bone scintigraphy should be included to staging protocol. Abdominal masses originated from neurogenic tissues (neuroblastoma) can accumulate Tc-99m MDP. We want to present a child with neuroblastoma and abdominal mass displacing the adjacent kidney and accumulating both I-131 MIBG and Tc-99m MDP.

Topics: 3-Iodobenzylguanidine; Abdominal Neoplasms; Bone and Bones; Humans; Infant; Iodine Radioisotopes; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In planning diagnostic or follow-up investigational strategies, neuroblastoma (NB) metastatic deposits in bone and/or bone marrow (BM) should be detected as early as possible. Therefore, all investigational detection tools should be conducted simultaneously for precise staging. However, because of the financial conditions in our developing countries and in view of the cost/benefit relationship, the question is, can one detection tool only become satisfactory and replacing others? The purpose of our study is to compare simultaneous results of bone and metaiodobenzylguanidine (MIBG) scans versus BM biopsies with immunohistochemical (IHC) staining; in detecting bone and/or BM metastatic deposits in NB patients.. This study included 138 NB patients; 46 were de novo and 92 were under follow-up. They were subjected to bilateral BM biopsies, IHC staining (using NSE McAb) and Tc-99m methylene diphosphonate (Tc-99m MDP) bone scan (BS). Only 57/138 patients were, in addition, subjected to I-131 MIBG scan.. Matched results between IHC-stained BM sections and bone scans (BSs) 107/138 (77.5%) were higher than the un-matched ones 31/138 (22.5%). There was a moderate agreement between the two methods in all studied cases (Kappa=0.538) and it was higher among de novo (Kappa=0.603) than follow-up group (Kappa=0.511). Among the 31 un-matched results, the most frequent (17/31) were due to the presence of minute amount of infiltrating NB cells that could be detected by IHC-stained BM sections and not by BSs. The less frequent (12/31) were due to the presence of metastatic deposits outside pelvic bones that could be detected by BSs and not by IHC-stained BM sections mainly in the follow-up cases (11/12) rather than de novo cases (1/12). The matched results between IHC-stained BM sections and MIBG scans 54/57 (94.7%) were higher than the un-matched ones 3/57 (5.3%). The agreement between the two methods was higher among de novo (Kappa=1.000) than follow-up group (Kappa=0.847). The agreement between IHC-stained BM sections and MIBG scans was substantial (Kappa=0.890) while that between IHC-stained BM sections and BSs was moderate (Kappa=0.538).. We suggest a step-wise strategy to be applied, at least in developing countries, in approaching de novo and follow-up NB cases for detecting bone and/or BM metastatic deposits. This strategy might be beneficial if it is considered during application of NB guide-lines for diagnosis and follow-up.

Topics: Adolescent; Bone Marrow; Bone Marrow Neoplasms; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Immunohistochemistry; Infant; Male; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: 3-Iodobenzylguanidine; Ataxia; Child, Preschool; Contrast Media; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Neuroblastoma; Opsoclonus-Myoclonus Syndrome; Radionuclide Imaging; Radiopharmaceuticals; Sympathetic Nervous System; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Neuroblastoma is the third most common malignancy of childhood. 131I-MIBG scintigraphy must be performed in patients with neuroblastoma at the time of staging. The aim of this study is to identify the role of 131I-MIBG scintigraphy in neuroblastoma patients in correlation with other diagnostic modalities for staging of the disease.. Twenty six patients provisionally diagnosed by clinical and imaging criteria to have neuroblastoma were included. On histopathologic verification 5 of these 26 patients were rediagnosed as non-neuroblastoma. Each patient had imaging by ultrasound, CT and/or MRI. In all cases, 131I-MIBG scintigraphy was performed, among them 15 patients had additional 99mTc-MDP bone scan.. The outcome demonstrated that CT and MRI were able to detect lesions in 19 out of 21 patients; while in 2 patients no lesions were detected. 131I-MIBG showed active lesions in 16 out of the above 19 patients, while in 3 patients 131I-MIBG was negative. There were no false positive result by 131I-MBG scan. Accordingly, 131I-MIBG is able to detect neuroblastora lesions with an overall sensitivity of 84.2%, specificity of 100% and an accuracy of 85.7%. Detection of primary lesions by 131I-MIB was significantly better than 99mTc-MDP bone scanning (92.31% vs. 61.54% respectively) (P < 0.05). For skeletal metastases, 131I-MIBG scan has a higher ability to detect more lesions than 99mTc-MDP bone scan (P = 0.023).. 131I-MIBG scintigraphy has an excellent ability to discriminate between neuroblastonia and other small round cell paediatric tumours. 131I-MIBG was found to be significantly superior to conventional bone scanning in revealing both primary and metastatic osseous lesions.

Topics: 3-Iodobenzylguanidine; Adolescent; Adrenal Gland Neoplasms; Bone Marrow Neoplasms; Brain Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Iodine Radioisotopes; Liver Neoplasms; Male; Mediastinal Neoplasms; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Retroperitoneal Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

The aim of this study is to clarify the period of extraosseous accumulation of (99m)Tc-hydroxymethylenediphosphonate (HMDP) to radiation nephropathy mimicking recurrent or remnant neuroblastoma in the pararenal region.. We reviewed five neuroblastoma and one ganglioneuroblastoma patients (2 boys and 4 girls aged 1-9 years) who underwent (99m)Tc-HMDP bone scintigraphies periodically before and after radiation therapy.. Increased renal uptake coincident with the radiation port appeared in 5 of 6 patients from 0 to 3 months (mean 1.7 months), and persisted up to 7 months after the completion of radiotherapy. Renal uptake of (99m)Tc-HMDP was gradually decreased, and eventually became accumulation defects in 5 of 6 patients from 6 to 17 months (mean 8.9 months) after radiotherapy.. When extraosseous accumulation is found after radiation therapy in neuroblastoma patients, radiation nephropathy would be a candidate in the differential diagnosis besides recurrent or remnant tumor.

Topics: Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Neoplasm Recurrence, Local; Neuroblastoma; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy; Technetium Tc 99m Medronate

Topics: 3-Iodobenzylguanidine; Abdominal Neoplasms; Humans; Infant; Iodine Radioisotopes; Male; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone scintigraphy (BS) is widely utilized for the assessment of bone metastases (BMs) of neuroblastoma (NB). Since 111In-pentetreotide scintigraphy (PS) has been used to image NB with high sensitivity, we compared the sensitivity and specificity of PS with that of BS for the detection of BMs of NB. Nine patients with NB underwent both PS and BS for staging and/or restaging of their disease. The sensitivity and specificity of both imaging approaches were compared based on the findings of histopathology, other conventional imaging methods and subsequent clinical follow-up. In five of the nine patients, both PS and BS were negative for BMs. Radiographic bone surveys (RBSs) were also negative in these patients, except in one who showed a suspicious tibial lesion, but a computed tomography-guided biopsy failed to show evidence of disease. These patients remained without clinical evidence of BMs after a median duration of more than 15 months (range, 6-19 months). In three of four remaining patients, both PS and BS were positive for BMs, whilst only PS was positive in one patient. Overall, PS showed a greater number of BMs (30 vs. 7) with greater conspicuity compared with BS. The initial experience comparing BS with PS suggests that PS may provide a better assessment of the extent of BMs of NB, and that it may be useful as an adjunct to BS at institutions in which 131I- or 123I-metaiodobenzylguanidine is not available, particularly if BS is negative. In patients with similarly positive BS, PS might still provide unique prognostic information beyond that provided by BS. Further studies are therefore warranted.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Neoplasms; Brain Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Male; Neuroblastoma; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Tc-99m sestamibi, originally developed for myocardial studies, has been used as a tumor-seeking agent. Recently, the agent also was reported to be a functional tracer to predict multidrug resistance-related p-glycoprotein expression in tumor tissue. The current report presents the authors' experience with sestamibi tumor scintigraphy in a neuroblastoma. Although I-131 MIBG tumor imaging and Tc-99m MDP bone scanning accurately demonstrated the extent of the disease, Tc-99m sestamibi showed no accumulation in primary and metastatic foci. Lack of sestamibi uptake was initially thought to be suggestive of failure to respond to chemotherapy because of p-glycoprotein expression. However, the patient responded well to chemotherapy and complete remission was achieved. The failure of Tc-99m sestamibi to detect a neuroblastoma and the lack of sestamibi accumulation in the tumor may not always be related to chemotherapy resistance.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child, Preschool; Drug Resistance, Neoplasm; False Negative Reactions; Gene Expression Regulation, Neoplastic; GTP-Binding Proteins; Humans; Male; Mediastinal Neoplasms; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Remission Induction; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Localization of skeletal tracer in a neuroblastoma primary is common but localization in extraskeletal metastatic sites has not received recognition. Tc-99m MDP concentration in hepatic or pulmonary metastases was noted in three of ten patients with such metastases. Lesion size appears to be important for demonstrating these metastases with Tc-99m MDP. This was particularly true for hepatic metastases, which were identified only when they were 5 cm or greater in diameter.

Topics: Bone and Bones; Calcinosis; Child; Child, Preschool; Contrast Media; Female; Follow-Up Studies; Gadolinium; Humans; Image Enhancement; Infant; Infant, Newborn; Liver Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Staging; Neuroblastoma; Radiography, Thoracic; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

At their initial emergency room presentation, four children were thought to have hip osteomyelitis. Skeletal scintigraphy, however, demonstrated multiple areas of abnormal tracer uptake in the bones in all four, and in three there was abnormal uptake in a soft tissue abdominal mass. The skeletal scintigraphic findings promptly led to the correct diagnosis of neuroblastoma.

Topics: Adrenal Gland Neoplasms; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Hip; Hip Joint; Humans; Infant; Male; Neuroblastoma; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Female; Humans; Infant; Leg; Mediastinal Neoplasms; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Nerves

In a group of 22 patients with a stage 4 neuroblastoma, MIBG and 99mTc-MDP scintigraphy and radiological skeletal survey were performed at diagnosis to assess the presence of metastatic skeletal disease. In 20 out of 22 patients the MIBG scan was repeated during follow-up at a time when maximum tumoral regression was expected, i.e. after 3-4 cycles of chemotherapy; scan results were correlated to clinical and laboratory data. At diagnosis MIBG scan showed bone involvement in 19/22 patients, 99mTc-MDP in 20/22 and radiological skeletal survey in 11/22. In 1 patient only marrow aspirate revealed diffusion of disease beyond the primitive lesion. A total of 117/161 (72%) bone lesions were detected by MIBG, 89/161 (55%) by 99mTc-MDP and 47/161 (29%) by radiological skeletal survey. MIBG scintigraphy revealed bone marrow involvement in 11/22 patients in whom either marrow aspirate or bone biopsy were positive. In 5 patients 14 soft tissue lesions were also discovered and all but one primitive lesion accumulated MIBG. Although MIBG scan detected a greater number of bone lesions than 99mTc-MDP, in two patients in whom MIBG scan was negative 99mTc-MDP revealed the presence of bone involvement. Therefore we conclude that 99mTc-MDP scan is necessary to fully assess bone involvement in neuroblastoma at diagnosis. When MIBG scan was repeated after chemotherapy there was a general reduction of the number of detected lesions and in 8/17 patients both bone metastases and marrow involvement could no longer be detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Contrast Media; Female; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Thirty-five children (aged 0-9 yr) who had presented with Stage IV neuroblastoma were studied to see if avidity for 67Ga or 99mTc-methylene diphosphonate (MDP) uptake in both primary and secondary sites at diagnosis conferred any prognostic significance. Twenty-three percent of the patients were disease free and off treatment at the time of study. Crude survival did not differ between groups. Duration of survival and the likelihood of completing treatment were related to the scintigraphic appearance at the time of diagnosis, after adjustment for potential confounding effects, using Cox's proportional hazards regression and multiple logistic regression. After adjustment for confounding influences, neither 67Ga avidity nor uptake of 99mTc-MDP was associated with a significantly worse prognosis, both in terms of adjusted survival and likelihood of completing treatment. Patients with 67Ga-avid scans at diagnosis did not demonstrate significantly worse survival (HR 1.47, 95% CI 0.43-5.11) than those without 67Ga avidity. They were somewhat less likely to complete treatment (OR 0.23, 95% CI 0.03-1.63), but this did not reach statistical significance. Similarly, although patients with 99mTc-MDP positive scans demonstrated somewhat worse survival (HR 2.47, 95% CI 0.45-13.54), this result did not reach statistical significance, nor were they less likely to complete treatment (OR 0.69, 95% CI 0.07-6.67) than those with 99mTc-MDP negative scans. Uptake of 99mTc-MDP into extraosseous sites was also not associated with worse survival (HR 1.45, 95% CI 0.58-3.62) nor with decreased likelihood of completing treatment (OR 0.78, 95% CI 0.12-5.09). Other than indicating disease stage, these results do not support the hypothesis that the scintigraphic appearance at diagnosis confers prognostic information in children with advanced neuroblastoma.

Topics: Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Citrates; Citric Acid; Female; Gallium; Gallium Radioisotopes; Humans; Infant; Male; Neuroblastoma; Prognosis; Radionuclide Imaging; Regression Analysis; Survival Rate; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child; Child, Preschool; Citrates; Citric Acid; Gallium; Gallium Radioisotopes; Humans; Infant; Neuroblastoma; Prognosis; Radionuclide Imaging; Risk Factors; Survival Analysis; Technetium Tc 99m Medronate

Topics: 3-Iodobenzylguanidine; Humans; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Eighty-Six patients of neuroblastoma ranging in age from four months to 15 years were studied with 99m Tc-MDP for total skeletal survey over a period of seven years (1983-1990). The diagnosis of neuroblastoma was based on bone marrow examination, FNAC, lymph node biopsy, histopathology. Bone imaging was performed three hrs. after intravenous administration of 99m Tc-MDP. Out of 86 patients, 45 patients had positive bone scan showing osseous concentration in 122 sites and extraosseous concentration in 34 sites. Seven patients had liver metastases. None of these liver metastases showed concentration of MDP. Fourteen patients underwent surgery for the primary tumour at the time of bone scanning. Ten patients were studied at the time of follow up, of which four patients showed good response as bony metastases were not demonstrated on bone scintigraphy and X-rays. In conclusion, bone scan is an useful test in neuroblastoma in delineating the bony metastases and also in assessing the efficacy of chemotherapy in these patients.

Topics: Abdominal Neoplasms; Adolescent; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Thoracic Neoplasms

Metaiodobenzylguanidine (MIBG) has been shown to be both sensitive and highly specific for the detection of neuroblastoma. However, controversy surrounds its sensitivity in detecting neuroblastoma when compared with radionuclide (technetium 99m-methylene diphosphonate [99mTc]-MDP) bone scans. Because a diagnostic test ideally should be easy to interpret in addition to being sensitive and specific, this study aims to determine the most efficacious scintigraphic agent for diagnostic use in neuroblastoma.. Twenty patients with neuroblastoma had a total of 26 paired MIBG and 99mTc-MDP bone scans obtained less than 4 weeks apart. Each study was evaluated independently of its counterpart by six separate observers (3 experienced and 3 inexperienced in MIBG scintigraphy) to determine the presence or absence of disease and the tumor burden.. Inexperienced observers reported more confidence in their interpretations of 99mTc-MDP bone scans; however, seven false-positive bone scans were reported. Using MIBG, all true-positive and true-negative scans, as well as significantly more sites of both primary and metastatic disease, were identified by all observers.. This study suggests that MIBG is the more efficacious agent for the scintigraphic evaluation of neuroblastoma.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Neoplasms; Contrast Media; Humans; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

The purpose of this study was to compare the utility of bone and metaiodobenzylguanidine (MIBG) scintigraphy for the detection of primary and metastatic deposits of neuroblastoma. 99mTc methylene diphosphonate (MDP) bone and 131I-MIBG scans performed within 1 mo of each other in 85 patients with known or suspected neuroblastoma were evaluated for evidence of skeletal and extraskeletal disease. In 77 of 77 patients with confirmed neuroblastoma, the MDP and MIBG scans were concordant for the presence or absence of skeletal disease. A nearly twofold greater number of skeletal lesions were evident on MIBG scanning. No patients with normal bone scans had MIBG studies indicating bone involvement. In patients with histologic evidence of bone marrow involvement, each study suggested skeletal lesions in approximately 70%. In patients with extraskeletal disease demonstrated by CT, there was soft-tissue uptake of MIBG in 80% and MDP in 39%. We conclude that both MIBG and MDP are useful for the detection of skeletal neuroblastoma. MIBG is the better agent for characterizing the extent of disease, and MDP is a valuable adjunctive agent that provides skeletal landmarks for comparison. MIBG is clearly superior for the detection of extraskeletal neuroblastoma.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Marrow Diseases; Bone Neoplasms; Child; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Topics: Abdominal Neoplasms; Adolescent; Female; Humans; Lung; Neuroblastoma; Pneumonia, Pneumocystis; Radionuclide Imaging; Technetium Tc 99m Medronate

The present study compares the reliability of MIBG and MDP bone scans in detecting bone metastases of neuroblastoma. Out of 57 patients, 23 had both 99mTc-MDP and 123I/131I-MIBG scans within a 2-week period. In 10 patients at primary diagnosis there was an underestimation of skeletal involvement by MIBG in 1/5, in 13 patients at follow-up in 3/9; 99mTc-MDP scans were able to visualize skeletal involvement in all those cases. There was only one false positive MDP scan. These results suggest that MIBG alone may fail to visualize skeletal involvement of neuroblastoma and should therefore be complemented by additional 99mTc-MDP scintigraphy.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Ganglioneuroma; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

This study was carried out to compare iodine-123 metaiodobenzylguanidine ([I123I]MIBG) and technetium-99m-methylene diphosphonate bone scans (99mTc-MDP) in the detection of skeletal involvement by neuroblastoma. Forty-four children with neuroblastoma underwent both [123I] MIBG and 99mTc-MDP scans within a 4-wk period; bone marrow examination also was performed; all these investigations were done both at diagnosis and at follow-up. At diagnosis, four children with Stage 4 disease had normal [123I]MIBG scans but abnormal 99mTc-MDP scans, while at follow-up there were four children with negative [123I]MIBG studies who later died from disseminated neuroblastoma. All eight scans are considered false-negative. In 24 children, the [123I]MIBG revealed more extensive disease with 161 positive sites while the 99mTc-MDP scan showed only 100 positive sites; 34 of these sites were common to both studies. This study shows that underassessment of skeletal involvement by neuroblastoma occurred using [123I]MIBG scans and that one cannot therefore substitute [123I]MIBG for 99mTc-MDP bone scans in the staging of neuroblastoma.

Topics: 3-Iodobenzylguanidine; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; False Negative Reactions; Female; Humans; Infant; Infant, Newborn; Iodine Radioisotopes; Iodobenzenes; Male; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Neuroblastoma is a potentially curable childhood malignancy with survival rates of 20% reported even in advanced disease. Technetium-labelled methylene diphosphonate (Tc99m-MDP) scanning is well established as a method of assessing bone disease. We report four patients, with advanced neuroblastoma in complete or partial remission, in whom new abnormalities on bone scintigraphy were due to benign lesions. Correct management depends on the precise diagnosis of such lesions.

Topics: Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Fourteen children with histopathologically confirmed neuroblastoma underwent sequential correlative imaging studies using I-131 MIBG, Tc-99m MDP, and Ga-67 citrate during various stages of the disease. Of the patients 86% showed I-131 MIBG accumulation in the primary tumoral site, whereas 71% showed Tc-99m MDP and 79% Ga-67 citrate uptake. In 86% at least one of the two latter radiopharmaceuticals concentrated in the primary tumor. The use of all three radiopharmaceuticals raised the detection rate to 93%. Of the osseous or extraosseous metastases 100% were detected by Tc-99m MDP studies. The I-131 MIBG studies were positive in 71% of the osseous metastases and in 70% of the extraosseous metastases. No Ga-67 citrate uptake was demonstrated in osseous metastases, although one extraosseous lung metastasis concentrated this radiopharmaceutical. Tc-99m MDP bone imaging was the best method for diagnosing metastatic spread of the disease and for monitoring the results of treatment. Primary tumor uptake was best indicated by I-131 MIBG. Both Ga-67 citrate and I-131 MIBG were superior to Tc-99m MDP with regard to accurately demonstrating the extent of primary tumors. Only Tc-99m MDP indicated the relationship of these tumors to the kidneys and neighboring osseous structures, providing early screening of kidney compression. Ga-67 citrate study was mainly indicated in tumors with catecholamine depletion, which failed to concentrate the other two radiopharmaceuticals. I-131 MIBG proved especially useful in detecting neuroblastoma with negative Tc-99m MDP and Ga-67 citrate studies and also proved to be helpful with those cases in which I-131 MIBG was planned for therapy. The following strategy is suggested for evaluating neuroblastoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 3-Iodobenzylguanidine; Bone and Bones; Child; Child, Preschool; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

We have been among the first authors to point out that false negative cases could be observed with 131I-MIBG scintigraphy for neuroblastoma. We have observed until now ten of such false negative cases, 7 with primary tumor and 3 with bone metastases. Fifty 131I-MIBG scans were performed in 35 children with histologically proven neuroblastoma (24 grade IV) and compared to bone scans, CT and NMR images, ultrasound and clinical results. The visualization of the primary tumor shows a higher sensitivity with MIBG (79%) than with bone scans (47%) and a 100% specificity with each method. MIBG and bone scans, for bone metastases, are similar in the sensitivity (87.5%) but MIBG is much more specific (100%) than bone scan (81%). These results clearly confirm the superiority of MIBG scan for detection of primary tumor as well as bone metastases. However, MIBG is not always the most appropriate investigation, as shown by 11 observed pitfalls. Ten false negative cases have been observed and must be considered: in five out of 10 cases, bone scans performed with 99m Tc-HMDP made the diagnosis (3/7 cases of primary tumor and 2/3 cases of bone metastases). Moreover, one case was not usable due to a large digestive uptake. Our aim is to understand the reasons of the false negative by a meticulous analysis of every single case. The optimal procedure for neuroblastoma diagnosis, extent and follow up clearly seems to be the following strategy: MIBG scan must be firstly performed; in case of non-demonstrative scan the bone scan, which is complementary, will greatly contribute to the diagnosis.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Neoplasm Metastasis; Neuroblastoma; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

Seventy children (3.7 +/- 3.3 y) with definitely confirmed diagnosis of neuroblastoma had 115 whole body scans carried out 24 h after injection of 3.7 MBq/kg of I-123 mIBG (83 scans) or 0.7 MBq/kg of I-131 mIBG (17 scans) or 0.9 to 4.5 GBq of I-131 mIBG (15 post-therapeutic scans). The scans were interpreted as positive in the presence of any non-physiological uptake area or of any bone uptake of the tracer, even at the level of the metaphyseal complex. For the primary tumour, the sensitivity of mIBG scans was 73%. Ten false negative patients had an overlap of the tumour with the bladder or heart images (4 cases) or with positive metastatic images (6 cases: liver, spine). Three false negative patients had neuroblastomas which did not secrete catecholamines. The specificity of mIBG was 94%. In our opinion, mIBG scans have a complementary role to assess the activity of post-therapeutic remnants. For the detection of hepatic and lymph node metastases, the sensitivity was about 50% and the specificity was 100%. The standard used for the detection of bone marrow metastases was the cytological and histological examination of 10 bone marrow aspirations and one or more biopsies (CHBMS). The sensitivity of mIBG scans was 90% and the specificity 68%. However, reviewing the data from the 16 false positive scans, we found 11 definitely proven bone metastases, 3 biological relapses and 2 cases of delayed abnormal CHBMS supporting the positivity of the mIBG scans, raising the specificity to 100%. Tc-99m diphosphonate bone scans had a sensitivity of 78% and a specificity of 51%. We suggest that positive mIBG scans may save other procedures since our data do not support false positive detection of bone or bone marrow metastases. In contrast, patients with negative mIBG findings should be further explored.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Lymphatic Metastasis; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Extraosseous uptake of radiophosphate compounds i well recognized in primary neural crest tumors. In a review of 32 cases of neuroblastoma presenting over a three-year period at Children's Hospital of Philadelphia, nine patients were noted to have secondary lesions in eleven different sites accumulating radiotracer. The extraosseous uptake in metastases included: ascites, liver, lung, anterior mediastinum, and posterior mediastinum. These cases are reported to emphasize the ability of bone imaging to detect the presence of extraosseous soft tissue metastases and primary lesions.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Ganglioneuroma; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Neuroblastoma is well recognized as a cause of soft tissue uptake of Tc-99m MDP. Two cases of neuroblastoma arising in the midline from the celiac axis are reported. Bone imaging performed on two separate days showed not only typical soft tissue uptake, but also the appearance of the radiopharmaceutical in the bowel. At surgery, a midline upper abdominal neuroblastoma was found in both patients without evidence of involvement of the liver, kidneys, bowel, gallbladder or mesentery. It became apparent with delayed images in the second patient that this activity was in the bowel and moving around the abdomen in a typical large bowel pattern. Bowel activity was not seen in other patients having bone scans at this time. Follow-up bone imaging on the first patient after resection of the tumor did not demonstrate diphosphonate activity in the bowel. These authors have never seen or read of this finding previously in this condition, and report it in these two patients.

Topics: Abdominal Neoplasms; Bone and Bones; Celiac Artery; Colon; Female; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

A new radiopharmaceutical, I-131 metaiodobenzylguanidine (I-131 MIBG) was used to determine the location and to follow-up tumors in a 13-month-old girl with neuroblastoma. I-131 MIBG imaging revealed both a primary abdominal tumor and a distant metastatic orbital tumor. Follow-up study with I-131 MIBG imaging demonstrated significant resolution of tumors after external radiotherapy and chemotherapy. I-131 MIBG imaging is a simple, safe, and specific method of determining the location of tumors and also is clinically useful in the evaluation and management of patients with neuroblastoma.

Topics: 3-Iodobenzylguanidine; Abdominal Neoplasms; Female; Follow-Up Studies; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Orbital Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Child, Preschool; Diphosphonates; Humans; Male; Neuroblastoma; Radionuclide Imaging; Skull Neoplasms; Technetium; Technetium Tc 99m Medronate

A case of unilateral nearly total hypoperfusion of the left lung in a 13-month-old girl is presented. The combination of the lung hypoperfusion and accumulation of the Tc-99m MDP and Ga-67 citrate in the same area suggested the preoperative diagnosis of mediastinal neuroblastoma. Explorative thoracotomy revealed the presence of a neuroblastoma compressing the left lung pedicle. The described scintigraphic appearance in the pediatric age group is suggested as typical of mediastinal neuroblastoma. This pathology should be included in the following gamuts in nuclear medicine: unilateral decrease or absent lung perfusion, unilateral diffuse chest uptake of Ga-67 citrate, and unilateral pulmonary uptake in bone scintigraphy.

Topics: Female; Gallium Radioisotopes; Humans; Infant; Lung; Mediastinal Neoplasms; Neuroblastoma; Perfusion; Radionuclide Imaging; Technetium Tc 99m Medronate

Fourteen children with histopathologically confirmed neuroblastoma underwent 38 studies using 99mTc-methylene-diphosphonate (MDP) and galliumcitrate Ga67 whole-body scintigraphy during various stages of the disease. Ten patients (71%) showed 99mTc-MDP accumulation in the primary tumoral site, whereas 11 patients (78.6%) showed 67Ga concentration. In 12 patients (86%), at least one of these two radiopharmaceuticals concentrated in the primary tumor. Nine patients had osseous or extraosseous metastases. All of these metastases (100%) were positive on 99mTc-MDP scintigraphy. No 67Ga-citrate uptake was demonstrable in osseous metastases; only one extraosseous lung metastasis concentrated this radiopharmaceutical. 67Ga-citrate was superior to 99mTc-MDP with regard to accurately demonstrating the extent of primary tumors. Only 99mTc-MDP indicated the relationship of the tumor to the kidneys and neighbouring osseous structures, providing early screening of kidney compression and possible damage caused by the tumor. From these results, we found these two methods to be complementary for the diagnosis and follow-up of neuroblastoma; their combined use resulted in high diagnostic accuracy and a considerable gain of information. We therefore recommend sequential 99mTc-MDP and 67Ga-citrate scans for the diagnosis and evaluation of the primary tumor; periodic 99mTc-MDP whole-body scans should be used in the follow-up of treatment, and for discovering disease exacerbations and metastases.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Gallium Radioisotopes; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Sixty-six percent of 54 patients with neuroblastoma demonstrated uptake of bone-seeking radioagents by the primary tumor. This is a higher incidence than previously reported. Uptake was slightly more common in abdominal than thoracic tumors. There was a significant correlation between the size of the tumor and tracer uptake. Calcification was demonstrated in the primary tumor in almost 90% of the 54 patients. This is a much higher incidence of calcification than previously reported. Microscopy shows that the calcification is not always due to tumor necrosis; it also occurs in areas of viable tumor cells. Tracer uptake is believed to be related to calcium metabolism. The rate of metabolic activity rather than the total amount of calcium present within the tumor may be the most important factor in determining the amount of uptake. No significant relationship was found between tracer uptake and tumor stage or homovanillic acid and vanillylmandelic acid metabolic activity.

Topics: Abdominal Neoplasms; Bone and Bones; Calcinosis; Diphosphonates; Etidronic Acid; Female; Homovanillic Acid; Humans; Infant; Male; Neuroblastoma; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Thoracic Neoplasms; Vanilmandelic Acid

A routine bone scan was performed on an infant presenting with abdominal mass. Initially, the stasis of activity in the right ureter, which was compressed by a large abdominal meningocoele, was mistaken for activity in a neuroblastoma. A subsequent kidney scintigram led to the correct interpretation. The misinterpretation of abdominal 99mTc-MDP accumulation can be prevented by the correlation of bone and kidney scintigrams. In this way, the correct site of the radiopharmaceutical concentration can be assessed, and the damage caused by any kind of abdominal mass to the compressed urinary tract and kidney can be assessed.

Topics: Abdominal Neoplasms; Bone and Bones; Diagnosis, Differential; Diphosphonates; Humans; Infant; Kidney; Male; Meningocele; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Angiography; Bone and Bones; Diphosphonates; Humans; Leg; Male; Neuroblastoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Brain Neoplasms; Child; Diphosphonates; Female; Humans; Infant; Male; Neuroblastoma; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Autopsy; Brain Neoplasms; Child; Diphosphonates; Humans; Male; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Of 42 radionuclide bone scans in 35 children with neuroblastoma, 21 were abnormal for the presence of skeletal metastases. Of the 21 abnormal scans, 16 were corroborated by positive bone-marrow biopsy or clinical data. The false-negative and false-positive rates for bone scanning were 4.8% and 9.5%, respectively. Calcification of the primary tumor was seen on pretreatment computed tomographic (CT) scans in 24 (89%) of 27 cases, while only 13 (48%) of 27 were detectable by plain radiographs. Uptake of technetium-99m methylene diphosphate (99mTc-MDP) by the primary tumor occurred in 20 of 27 cases, but correlation between tumor uptake and calcification was not statistically significant. All children with markedly elevated urinary vanillylmandelic acid exhibited primary tumor uptake. Survival was not affected independently by primary tumor uptake.

Topics: Bone Neoplasms; Calcinosis; Child; Diphosphonates; False Negative Reactions; False Positive Reactions; Humans; Neuroblastoma; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Vanilmandelic Acid

Topics: Adrenal Gland Neoplasms; Adult; Bone and Bones; Diphosphonates; Female; Humans; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Technetium-99m methylene diphosphonate (99mTc MDP) imaging was performed in 29 consecutive children with abdominal masses. Dynamic images of the inferior vena cava were obtained by injecting the radiotracer in the feet. Serial renal images were obtained for the next 30 min. Routine bone imaging was performed at about 3 hr. The radionuclide studies of the inferior vena cava accurately diagnosed total obstruction and displacement to the left but not partial obstruction and displacement to the right. The abnormalities on early renal imaging included displacement (14), distortion (seven), obstruction (eight), and nonvisualization (one). All patients with Wilms tumor (eight) had either nonvisualized or distorted renal parenchyma. Patients with neuroblastoma (17) and other tumors (four) had displacement and obstruction. Soft-tissue accumulation of 99mTc MDP was noted in two Wilms tumors and 12 neuroblastomas.

Topics: Abdominal Neoplasms; Child; Diphosphonates; Humans; Kidney Neoplasms; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Vena Cava, Inferior; Wilms Tumor

Topics: Adrenal Gland Neoplasms; Diphosphonates; Female; Humans; Infant; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Diphosphonates; Head and Neck Neoplasms; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Adrenal Gland Neoplasms; Child, Preschool; Diphosphonates; Humans; Kidney; Male; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Forty patients, ages three days to 12 years, with neuroblastomas had bone scans with 99mtechnetium methylene diphosphonate (99mTc-MDP) as part of their pretreatment examination. Twenty-four (60%) had primary tumor uptake and 16 (40%) did not. No difference was seen between the two groups in the incidence of tumor calcification or necrosis. No relationship between the level of urinary vanillylmandelic acid (VMA) and the presence of primary tumor uptake of 99mTc-MDP was found. The possible causes for the localization of 99mTc-MDP are discussed.

Topics: Adrenal Gland Neoplasms; Bone and Bones; Calcinosis; Child; Child, Preschool; Diphosphonates; Female; Humans; Infant; Infant, Newborn; Male; Mediastinal Neoplasms; Necrosis; Neuroblastoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Vanilmandelic Acid