Nuclear medicine and multimodality imaging of pediatric neuroblastoma
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REVIEW
Nuclear medicine and multimodality imaging of pediatric neuroblastoma Wolfgang Peter Mueller & Eva Coppenrath & Thomas Pfluger
Received: 22 May 2012 / Revised: 22 June 2012 / Accepted: 23 June 2012 / Published online: 14 November 2012 # Springer-Verlag 2012
Abstract Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging. Keywords Neuroblastoma . Diagnosis . Iodobenzylguanidine . Scintigraphy . Positron emission tomography . Multimodality imaging . Child W. P. Mueller (*) : T. Pfluger Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1, 80336 Munich, Germany e-mail: [email protected] E. Coppenrath Department of Radiology, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1, 80336 Munich, Germany
Introduction Neuroblastoma is the most common extracranial solid malignancy in children (about 8% of pediatric malignancies) and remains, despite treatment intensification, responsible for approximately 15% of cancer deaths in children [1–4]. It is an embryonic tumor arising from the neural crest cells, which give rise to the adrenal medulla and the sympathetic nervous system [5]. The tumor is most frequently situated in the adrenal gland or elsewhere along the sympathetic nervous system chain [1]. At diagnosis, roughly 50% of patients have distant hematogenous metastases [6]. There is strong evidence that initial staging of neuroblastoma remains decisive with respect to risk stratification in order to choose the most appropriate treatment option [3, 7]. Imaging of neuroblastoma consists of sonography, CT, MRI, and radionuclide examinations such as scintigraphic bone scanning, metaiodobenzylguanidine (MIBG) scintigraphy, PET with different tracers ([F-18]2-fluoro-2-deoxyglucose [FDG], fluorodopa F18 [18F-DOPA], somatostatin receptor agonists), as well as hybrid imaging (PET/CT and SPECT/CT) [8–19
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