Neuroblastoma imaging: From MIBG to advanced PET tracers

Area of Science:

• Pediatric Oncology
• Molecular Imaging
• Radiopharmaceuticals

Background:

• Neuroblastoma is a common childhood extracranial solid malignancy with significant mortality.
• It exhibits diverse biological behavior, necessitating accurate diagnostic and prognostic tools.
• Molecular imaging is crucial for diagnosis, staging, risk stratification, and treatment monitoring.

Purpose of the Study:

• To review the evolution of neuroblastoma molecular imaging techniques.
• To highlight the strengths, limitations, and emerging roles of various radiopharmaceuticals.
• To discuss the transition from MIBG scintigraphy to advanced PET tracers and theranostic approaches.

Main Methods:

• Review of established and novel radiopharmaceuticals for neuroblastoma imaging.
• Analysis of meta-iodobenzylguanidine (MIBG) scintigraphy and its role.
• Evaluation of positron emission tomography/computed tomography (PET/CT) tracers including 18F-FDG, 18F-FDOPA, and somatostatin receptor imaging.

Main Results:

• 131/123I-MIBG scintigraphy remains a cornerstone due to high specificity for norepinephrine transporter-expressing tumors.
• PET/CT tracers like 18F-FDG, 18F-FDOPA, and somatostatin receptor imaging offer complementary information and address MIBG limitations.
• Novel tracers demonstrate potential for improved sensitivity, prognostic value, and theranostic applications.

Conclusions:

• Molecular imaging has significantly evolved, offering more precise diagnostic and therapeutic guidance for neuroblastoma.
• Advanced PET tracers complement or surpass MIBG in specific scenarios, improving detection and risk stratification.
• Emerging theranostic approaches integrate imaging with targeted radionuclide therapy for better patient outcomes.