Integrated imaging using MRI and 123I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma

• Published in: American journal of roentgenology (1976) Vol. 181; no. 4; pp. 1115 - 1124
• Main Authors: PFLUGER, Thomas, SCHMIED, Christoph, PORN, Ute, LEINSINGER, Gerda, VOLLMAR, Christian, DRESEL, Stefan, SCHMID, Irene, HAHN, Klaus
• Format: Journal Article
• Language: English
• Published: Leesburg, VA American Roentgen Ray Society 01.10.2003
• Subjects: Biological and medical sciences; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Iodobenzenes; Magnetic Resonance Imaging; Male; Medical sciences; Neuroblastoma - diagnosis; Neurology; Retrospective Studies; Sensitivity and Specificity; Tumors of the nervous system. Phacomatoses; Radionuclide study; Human; Pediatrics; Nervous system diseases; Malignant tumor; Neuroblastoma; Scintigraphy; Nuclear magnetic resonance imaging; Sensitivity; Specificity; Medical imagery; Diagnosis; Technique; Autonomic neuropathy; Child; Comparative study; Iodine ion
• ISSN: 0361-803X

The objectives of this study were to compare MRI and iodine-123 ((123)I) metaiodobenzylguanidine (MIBG) scintigraphy in the detection of neuroblastoma lesions in pediatric patients and to assess the additional value of combined imaging. Fifty MRI and 50 (123)I MIBG examinations (mean interval, 6.4 days) were analyzed retrospectively with regard to suspected or proven neuroblastoma lesions (n = 193) in 28 patients. MRI and MIBG scans were reviewed by two independent observers each. Separate and combined analyses of MRI and MIBG scintigraphy were compared with clinical and histologic findings. With regard to the diagnosis of neuroblastoma lesion, MIBG scintigraphy, MRI, and combined analysis showed a sensitivity of 69%, 86%, and 99% and a specificity of 85%, 77%, and 95%, respectively. On MRI, 15 false-positive findings were recorded: posttherapeutic reactive changes (n = 10), benign adrenal tumors (n = 3), and enlarged lymph nodes (n = 2). On MIBG scintigraphy, 10 false-positive findings occurred: ganglioneuromas (n = 2), benign liver tumors (n = 2), and physiologic uptake (n = 6). Thirteen neuroblastoma metastases and two residual masses under treatment with chemotherapy were judged to be false-negative findings on MRI. Two primary or residual neuroblastomas and one orbital metastasis were misinterpreted as Wilms' tumor, reactive changes after surgery, and rhabdomyosarcoma on MRI. Thirty-two bone metastases, six other neuroblastoma metastases, and one adrenal neuroblastoma showed no MIBG uptake. On combined imaging, one false-negative (bone metastasis) and three false-positive (two ganglioneuromas and one pheochromocytoma) findings remained. In the assessment of neuroblastoma lesions in pediatric patients, MRI showed a higher sensitivity and MIBG scintigraphy a higher specificity. However, integrated imaging showed an increase in both sensitivity and specificity.