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Multicenter analysis of [123I/131I]I-mIBG imaging in pediatric neuroblastoma - effective dose estimation
Małgorzata Poniatowska-Roszkowska1,2,3, Mark O Wielpütz4,5, Hanna Piwowarska-Bilska6
1Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany. malgorzata.poniatowska@pum.edu.pl.
Background:
Neuroblastoma is the most common extracranial solid tumor in children, predominantly affecting patients under 10 years. Due to therapeutic challenges, most patients are treated in specialized pediatric oncology centers. [¹²³I/¹³¹I]I-mIBG scintigraphy plays a crucial role in the diagnosis, staging, assessment of treatment response and long-term follow-up of patients with neuroblastoma. This study is part of the TEMICARE 2.0 project, which aims to improve the health and psychosocial well-being of patients with neuroblastoma in the Pomerania Euroregion. The aim of this study was to retrospectively analyze the use of [¹²³I/¹³¹I]I-mIBG imaging in the diagnosis of neuroblastoma in children and to compare clinical practice at participating centers.
Material And Methods:
Patients with suspected or confirmed neuroblastoma who underwent [¹²³I] or [¹³¹I]I-mIBG scintigraphy at two pediatric oncology centers in Poland and Germany from 2019-2024 were retrospectively included. Acquisition parameters were collected in a standardized manner.
Results:
A total of 320 examinations were performed in 88 patients. At Site 1, 190 studies were performed using [¹³¹I]I-mIBG, whereas 130 studies using [¹²³I]I-mIBG were conducted at Site 2. The mean age of the patients was 3 years (range: 1 month-14 years). The average number of examinations per patient was four. The mean cumulative effective dose delivered to patients during all examinations with [¹²³I]I-mIBG was 123 mSv, compared with 207 mSv for [¹³¹I]I-mIBG, representing an approximately 40% lower dose with [¹²³I]I-mIBG.
Conclusions:
[¹²³I]I-mIBG imaging is an essential tool for disease staging and monitoring treatment response in patients with neuroblastoma. Current guidelines recommend the use of [¹²³I]I-mIBG because of its superior diagnostic performance and more favorable radiation dosimetry profile. However, the availability of this radiopharmaceutical remains limited due to higher costs and the logistical challenges associated with transportation to centers located far from production facilities.
