Nuclear Medicine Imaging in Neuroblastoma: Current Status and New Developments.
Samim Atia,Tytgat Godelieve A M,Bleeker Gitta,Wenker Sylvia T M,Chatalic Kristell L S,Poot Alex J,Tolboom Nelleke,van Noesel Max M,Lam Marnix G E H,de Keizer Bart
Journal of personalized medicine
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 -[I]iodobenzylguanidine ([I]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]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]mIBG, [F]mFBG, [F]FDG, [Ga]Ga-DOTA peptides, [F]F-DOPA, and [C]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.
Diagnostic Value of Seven Different Imaging Modalities for Patients with Neuroblastic Tumors: A Network Meta-Analysis.
Wang Yu,Xu Yanfeng,Kan Ying,Wang Wei,Yang Jigang
Contrast media & molecular imaging
Objective:We performed a systematic review and network meta-analysis (NMA) to compare the diagnostic value of seven different imaging modalities for the detection of neuroblastic tumors in diverse clinical settings. Methods:PubMed, Embase, Medline, and the Cochrane Library were searched to identify eligible studies from inception to Sep 29, 2020. Quality assessment of included studies was appraised with Quality Assessment of Diagnostic Accuracy Studies. Firstly, direct pairwise meta-analysis was conducted to calculate the pooled estimates of odds ratio (OR) and 95% confidence interval (CI) of the sensitivity, specificity, NPV, PPV, and DR. Next, NMA using Bayesian methods was performed. The superiority index was assessed to quantify the rank probability of a diagnostic test. The studies performed SPECT/CT or SPECT were analyzed separately from the ones only performed planar imaging. Results:A total of 1135 patients from 32 studies, including 7 different imaging modalities, were eligible for this NMA. In the pairwise meta-analysis, F-FDOPA PET/CT had a relatively high value of all the outcomes (sensitivity: 10.195 [5.332-19.493]; specificity: 17.906 [5.950-53.884]; NPV: 16.819 [7.033-40.218]; PPV: 11.154 [4.216-29.512]; and DR 5.616 [3.609-8.739]). In the NMA, F-FDOPA PET/CT exhibited relatively high sensitivity in all subgroups (all data: 0.94 [0.87-0.98]; primary tumor: 0.89 [0.53-1]; bone/bone marrow metastases: 0.96 [0.83-1]; and primary tumor and metastases ( + ): 0.92 [0.80-0.97]), the highest specificity in the subgroup of + (0.85 [0.61-0.97]), and achieved the highest superiority index in the subgroups of all data (8.57 [1-15]) and + (7.25 [1-13]). Conclusion:F-FDOPA PET/CT exhibited the best diagnostic performance in the comprehensive detection of primary tumor and metastases for neuroblastic tumors, followed by Ga-somatostatin analogs, I-meta-iodobenzylguanidine (MIBG), F-FDG, and I-MIBG tomographic imaging.