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Added Value of SPECT/CT for Correlation of MIBG Scintigraphy and Diagnostic CT in Neuroblastoma and Pheochromocytoma

Katia Rozovsky1, Benjamin Z. Koplewitz1, Yodphat Krausz2, Shoshana Revel-Vilk3, Michael Weintraub3, Roland Chisin2 and Martine Klein2

1 Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
2 Department of Medical Biophysics and Nuclear Medicine, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91000, Israel.
3 Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.


Figure 1
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  		Fig. 1A —4-year-old girl after multiple surgical procedures for neuroblastoma. Diagnostic CT image shows catheter in inferior vena cava (IVC) that was inserted through femoral vein and up to right atrium.

 

Figure 2
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  		Fig. 1B —4-year-old girl after multiple surgical procedures for neuroblastoma. MIBG SPECT/CT images (CT, B; SPECT, C; and fused images, D) show pathologic MIBG uptake medial to catheter in IVC.

 

Figure 3
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  		Fig. 1C —4-year-old girl after multiple surgical procedures for neuroblastoma. MIBG SPECT/CT images (CT, B; SPECT, C; and fused images, D) show pathologic MIBG uptake medial to catheter in IVC.

 

Figure 4
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  		Fig. 1D —4-year-old girl after multiple surgical procedures for neuroblastoma. MIBG SPECT/CT images (CT, B; SPECT, C; and fused images, D) show pathologic MIBG uptake medial to catheter in IVC.

 

Figure 5
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  		Fig. 1E —4-year-old girl after multiple surgical procedures for neuroblastoma. Follow-up diagnostic CT image (4 months later) confirms relapse of neuroblastoma (arrow).

 

Figure 6
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  		Fig. 2A —5.6-year-old boy with neuroblastoma. Images show follow-up after treatment and disappearance of initial abdominal mass. There is pre- and paravertebral MIBG uptake that was overlooked on contrast-enhanced CT. Contrast-enhanced CT image shows minimal pre- and right paravertebral soft-tissue thickening (arrows).

 

Figure 7
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  		Fig. 2B —5.6-year-old boy with neuroblastoma. Images show follow-up after treatment and disappearance of initial abdominal mass. There is pre- and paravertebral MIBG uptake that was overlooked on contrast-enhanced CT. MIBG SPECT/CT images (CT, left column; SPECT, center column; and fused images, right column) show pathologic MIBG uptake in pre- and right paravertebral region.

 

Figure 8
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  		Fig. 2C —5.6-year-old boy with neuroblastoma. Images show follow-up after treatment and disappearance of initial abdominal mass. There is pre- and paravertebral MIBG uptake that was overlooked on contrast-enhanced CT. MIBG SPECT/CT images (CT, left column; SPECT, center column; and fused images, right column) 3 months later confirm tumor growth. Note difference of liver uptake between B and C, most likely due to imbalance in tracer distribution caused by pathologically intense tumor uptake.

 

Figure 9
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  		Fig. 3A —3-year-old boy with neuroblastoma. Images show follow-up after treatment and soft-tissue changes in left iliac region. Contrast-enhanced CT image shows nonspecific soft-tissue changes in iliac region (arrows).

 

Figure 10
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  		Fig. 3B —3-year-old boy with neuroblastoma. Images show follow-up after treatment and soft-tissue changes in left iliac region. MIBG SPECT/CT images (CT, left column; SPECT, center column; and fused images, right column) show pathologic MIBG uptake that was considered indicative of involved lymph node on CT of SPECT/CT.

 

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