Diagnostic Value of Seven Different Imaging Modalities for Patients with Neuroblastic Tumors: A Network Meta-Analysis

Current Status and Future Perspective on Molecular Imaging and Treatment of Neuroblastoma

Neuroblastoma is the most common extracranial solid tumor in children and arises from anywhere along the sympathetic nervous system. It is a highly heterogeneous disease with a wide range of prognosis, from spontaneous regression or maturing to highly aggressive. About half of pediatric neuroblastoma patients develop the metastatic disease at diagnosis, which carries a poor prognosis. Nuclear medicine plays a pivotal role in the diagnosis, staging, response assessment, and long-term follow-up of neuroblastoma. And it has also played a prominent role in the treatment of neuroblastoma. Because the structure of metaiodobenzylguanidine (MIBG) is similar to that of norepinephrine, 90% of neuroblastomas are MIBG-avid. 123I-MIBG whole-body scintigraphy is the standard nuclear imaging technique for neuroblastoma, usually in combination with SPECT/CT. However, approximately 10% of neuroblastomas are MIBG nonavid. PET imaging has many technical advantages over SPECT imaging, such as higher spatial and temporal resolution, higher sensitivity, superior quantitative capability, and whole-body tomographic imaging. In recent years, various tracers have been used for imaging neuroblastoma with PET. The importance of patient-specific targeted radionuclide therapy for neuroblastoma therapy has also increased. 131I-MIBG therapy is part of the front-line treatment for children with high-risk neuroblastoma. And peptide receptor radionuclide therapy with radionuclide-labeled somatostatin analogues has been successfully used in the therapy of neuroblastoma. Moreover, radioimmunoimaging has important applications in the diagnosis of neuroblastoma, and radioimmunotherapy may provide a novel treatment modality against neuroblastoma. This review discusses the use of current and novel radiopharmaceuticals in nuclear medicine imaging and therapy of neuroblastoma.

Clinical value of 18F-FDG PET/CT to predict MYCN gene, chromosome 1p36 and 11q status in pediatric neuroblastoma and ganglioneuroblastoma

Objective

To explore the value of ¹⁸F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/computed tomography(CT) in MYCN gene and chromosome 1p36 and 11 statuses in newly diagnosed pediatric NB(neuroblastoma) and GNB(ganglioneuroblastoma).

Methods

We retrospectively analyzed newly diagnosed patients with 48 NB and 12 with GNB in our hospital. The data obtained from the clinical medical records included age, sex, pathologic type, and laboratory parameters such as lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and the status of MYCN gene and chromosome 1p36 and 11q. The bone conditions were also obtained in the examination of bone marrow biopsy. Primary tumors were manually segmented to measure the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), tumor volume(MTV) and total lesion glycolysis(TLG) and the maximal length of the lesion in the axial image(LEGmax).

Results

The differences in bone marrow involvement and lymph node metastases in patients with chromosome 11q deletions were statistically significant (all p < 0.05). Chromosome 11q deletion was an independent factor affecting bone marrow involvement (OR=17.796, p=0.011). The levels of NSE, LDH, LEGmax and SUVmax, SUVmean, MTV, TLG all predicted MYCN gene amplification (all p < 0.05). The levels of LDH, LEGmax and MTV, TLG all predicted deletions in chromosomes 1p36 (all p < 0.05), while NSE, SUVmax and SUVmean did not (all p > 005).

Conclusion

The LDH levels, LEGmax, MTV and TLG can effectively predict the status of the MYCN oncogene and chromosome 1p36 in pediatric neuroblastoma and ganglioneuroblastoma. Those patients with chromosome 11q deletions are more likely to develop bone marrow involvement and lymph node metastases, showing a worse progression-free survival.

Comparing the diagnostic value of 18F-FDG PET/CT scan and bone marrow biopsy in newly diagnosed pediatric neuroblastoma and ganglioneuroblastoma

Objective

This study aims to compare the diagnostic value of ¹⁸F-fluorodeoxyglucose (18-FDG) positron emission tomography (PET)/computed tomography (CT) (¹⁸F-FDG PET/CT) scan and bone marrow biopsy (BMB) for evaluating bone marrow infiltration (BMI) in newly diagnosed pediatric neuroblastoma (NB) and ganglioneuroblastoma (GNB).

Methods

We retrospectively reviewed 51 patients with newly diagnosed NB and GNB between June 1, 2019 and May 31, 2022. Each patient had undergone ¹⁸F-FDG PET/CT and BMB within 1 week and received no treatment. Clinical data were collected and statistically analyzed, including age, sex, pathologic type, and laboratory parameters. ¹⁸F-FDG PET/CT and BMB revealed the result of bone lesions.

Results

A concordance analysis showed that, in this study population, ¹⁸F-FDG PET/CT and BMB were in moderate agreement (Cohen's Kappa = 0.444; p = 0.001), with an absolute agreement consistency of 72.5% (37 of 51). The analysis of the receiver operating characteristic (ROC) curve determined that the areas under the ROC curve (AUCs) of SUV_BM and SUV/HE-SUVmax were 0.971 (95% CI: 0.911-1.000; p < 0.001) and 0.917 (95% CI: 0.715-1.000; p < 0.001) to predict bone-bone marrow involvement (BMI), respectively.

Conclusion

¹⁸F-FDG PET/CT detects BMI with good diagnostic accuracy and can reduce unnecessary invasive inspections in newly diagnosed pediatric NB and GNB, especially patterns C and D. The analysis of the semi-quantitative uptake of ¹⁸F-FDG, including SUV_BM and SUV_BM/HE-SUVmax, enables an effective differentiation between patterns A and B.