Integrated Imaging Using MRI and 123| Metaiodobenzylguanidine Scintigraphy to Improve Sensitivity and Specificity in the Diagnosis of Pediatric Neuroblastoma
Thomas Pfluger1,
Christoph Schmied1,
Ute Porn1,
Gerda Leinsinger2,
Christian Vollmar1,
Stefan Dresel1,
Irene Schmid3 and
Klaus Hahn1
1 Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich,
Ziemssenstr. 1, D-80336 Munich, Germany.
2 Institute for Clinical Radiology, Ludwig-Maximilians-University of Munich,
Ziemssenstr. 1, D-80336 Munich, Germany.
3 Department of Pediatrics, Dr. von Haunersches Kinderspital,
Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, D-80337 Munich,
Germany.
View larger version (115K):
[in a new window]
|
Fig. 1A. —8-month-old girl with stage IV neuroblastoma who presented
with multiple bony metastases. MRI from STIR sequence shows high signal in two
metastases in left iliac bone and second lumbar vertebra (arrows)
(true-positive findings).
|
|
View larger version (134K):
[in a new window]
|
Fig. 1B. —8-month-old girl with stage IV neuroblastoma who presented
with multiple bony metastases. In corresponding regions, planar iodine-123
(123I) metaiodobenzylguanidine (MIBG) scintigrams show no uptake
(false-negative findings). Strong uptake can be seen in mediastinal primary
tumor. RVL = right side, ventral view, left side; LDR = left side, dorsal
view, right side.
|
|
View larger version (96K):
[in a new window]
|
Fig. 1C. —8-month-old girl with stage IV neuroblastoma who presented
with multiple bony metastases. Corresponding coronal (cor) SPECT
reconstructions of 123I MIBG scintigraphy support findings of
planar images (B).
|
|
View larger version (164K):
[in a new window]
|
Fig. 2A. —10-month-old boy with stage IV neuroblastoma. Fat-saturated
T1-weighted spin-echo image reveals large abdominal tumor (arrows),
originating from left adrenal gland, with inhomogeneous internal structure and
strong contrast enhancement (true-positive finding).
|
|
View larger version (99K):
[in a new window]
|
Fig. 2B. —10-month-old boy with stage IV neuroblastoma. Iodine-123
metaiodobenzylguanidine scintigram does not show uptake in this primary tumor
(false-negative finding). However, metastases in frontal skull, orbits, and
left mandibular bone are depicted. RVL = right side, ventral view, left side;
LDR = left side, dorsal view, right side.
|
|
View larger version (123K):
[in a new window]
|
Fig. 2C. —10-month-old boy with stage IV neuroblastoma. T1-weighted
spin-echo image confirms bone metastasis (arrows) of mandibular bone
and soft-tissue involvement in comparison with healthy right side
(arrowheads).
|
|
View larger version (147K):
[in a new window]
|
Fig. 3A. —2-year-old boy with reactive changes 1 year after resection
of stage III neuroblastoma. Paravertebral contrast-enhancing mass
(arrows) is visible on T1-weighted image. Differentiation between
residual tumor and reactive changes is not possible with MRI (false-positive
finding).
|
|
View larger version (83K):
[in a new window]
|
Fig. 3B. —2-year-old boy with reactive changes 1 year after resection
of stage III neuroblastoma. Planar iodine-123 (123I)
metaiodobenzylguanidine (MIBG) scintigrams reveal true-negative finding. RVL =
right side, ventral view, left side; LDR = left side, dorsal view, right
side.
|
|
View larger version (76K):
[in a new window]
|
Fig. 3C. —2-year-old boy with reactive changes 1 year after resection
of stage III neuroblastoma. Coronal (cor) SPECT reconstructions of
123I MIBG scintigraphy support negative finding of planar images
(B). True-negative diagnosis was confirmed by biopsy and follow-up
control examinations over 2 years.
|
|
View larger version (160K):
[in a new window]
|
Fig. 4A. —6-year-old boy with large neuroblastoma originating from left
adrenal gland. Coronal T2-weighted image reveals large mass in left abdomen
(arrows) with appearance typical of Wilms' tumor with pseudocapsule
and apparent origin from kidney (arrowheads) (false-negative finding
with regard to diagnosis of neuroblastoma).
|
|
View larger version (115K):
[in a new window]
|
Fig. 4B. —6-year-old boy with large neuroblastoma originating from left
adrenal gland. Corresponding transverse T1-weighted image depicts large mass
(arrows).
|
|
View larger version (87K):
[in a new window]
|
Fig. 4C. —6-year-old boy with large neuroblastoma originating from left
adrenal gland. Strong focal uptake by mass visible on iodine-123
metaiodobenzylguanidine scintigrams led to correct diagnosis of neuroblastoma
(true-positive finding). RVL = right side, ventral view, left side; LDR = left
side, dorsal view, right side.
|
|
View larger version (123K):
[in a new window]
|
Fig. 4D. —6-year-old boy with large neuroblastoma originating from left
adrenal gland. Transverse (tra) SPECT reconstructions that correlate to MRIs
show tumor extent and central tumor necrosis.
|
|
View larger version (108K):
[in a new window]
|
Fig. 5A. —Images of 5-year-old girl with left-sided adrenal
neuroblastoma that were obtained before and after chemotherapy. Transverse
T1-weighted image obtained before chemotherapy shows large tumor in left
abdomen (arrows) (true-positive finding).
|
|
View larger version (34K):
[in a new window]
|
Fig. 5B. —Images of 5-year-old girl with left-sided adrenal
neuroblastoma that were obtained before and after chemotherapy. Transverse
(tra) SPECT images from iodine-123 (123I) metaiodobenzylguanidine
(MIBG) scintigraphy obtained before chemotherapy reveal pathologic uptake in
corresponding region (arrows) (true-positive finding).
|
|
View larger version (98K):
[in a new window]
|
Fig. 5C. —Images of 5-year-old girl with left-sided adrenal
neuroblastoma that were obtained before and after chemotherapy. Transverse
T1-weighted image obtained after chemotherapy shows primary tumor
(arrow) is in complete remission. Normal structure of adrenal gland
can be seen (false-negative finding).
|
|
View larger version (39K):
[in a new window]
|
Fig. 5D. —Images of 5-year-old girl with left-sided adrenal
neuroblastoma that were obtained before and after chemotherapy. Transverse
(tra) SPECT images from 123I MIBG scintigraphy obtained after
chemotherapy reveal diminishing but persistent pathologic uptake in
corresponding region (arrows). Follow-up examinations (not shown)
confirmed tumor persistence (true-positive finding).
|
|
View larger version (149K):
[in a new window]
|
Fig. 6A. —4-year-old boy with right-sided pheochromocytoma. Clinically,
patient presented with hypertension and increased level of catecholamines.
T2-weighted image shows tumor of right adrenal gland (arrows).
Because of its origin and internal structure, lesion was classified as
neuroblastoma (false-positive finding). Correct diagnosis of pheochromocytoma
was proven by histology.
|
|
View larger version (78K):
[in a new window]
|
Fig. 6B. —4-year-old boy with right-sided pheochromocytoma. Clinically,
patient presented with hypertension and increased level of catecholamines.
Coronal (cor) SPECT images from iodine-123 metaiodobenzylguanidine
scintigraphy do not support diagnosis of right-sided neuroblastoma or
pheochromocytoma. On other hand, strong physiologic uptake in left adrenal
gland (arrows) was misinterpreted as neuroblastoma (false-positive
finding).
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2003 by the American Roentgen Ray Society.
