Challenges and Pitfalls in MIBG Imaging: A Systematic Review

Area of Science:

• Nuclear Medicine
• Oncology
• Diagnostic Imaging

Background:

• Metaiodobenzylguanidine (MIBG) scintigraphy is crucial for diagnosing neuroendocrine tumors like pheochromocytoma and neuroblastoma.
• False-positive MIBG uptake presents a significant challenge, potentially leading to misdiagnosis.

Purpose of the Study:

• To systematically review and summarize reported pitfalls causing false-positive MIBG scintigraphy findings.
• To identify common locations and etiologies of false-positive MIBG uptake.

Main Methods:

• Systematic literature search of PubMed and Scopus (1980-November 2024) for studies reporting false-positive MIBG uptake.
• Inclusion of case reports, case series, and observational studies; risk of bias assessment using QUADAS-2 and CARE checklist.
• Analysis of 91 studies documenting 170 false-positive cases.

Main Results:

• False-positive MIBG uptake most commonly occurred in the abdomen/pelvis (57.6%), followed by soft tissues/skeletal system (31.8%).
• Adrenal glands were the most frequent site, complicating pheochromocytoma diagnosis.
• Etiologies included non-tumoral conditions, benign/malignant tumors, and physiological variants.

Conclusions:

• Awareness of MIBG scintigraphy pitfalls is essential for accurate neuroendocrine tumor diagnosis.
• Clinical correlation, hybrid imaging, and complementary diagnostics are vital to reduce misinterpretation.
• This review provides a comprehensive overview of false-positive findings to enhance diagnostic precision.