Gauguet Jean-Marc, Pace-Emerson Tamara, Grant Frederick D, Shusterman Suzanne, DuBois Steven G, Frazier A Lindsay, Voss Stephan D
Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts.
Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26601. Epub 2017 Apr 27.
Accurate staging of neuroblastoma requires multiple imaging examinations. The purpose of this study was to determine the relative contribution of Tc-methylene diphosphonate (MDP) bone scintigraphy (bone scan) versus metaiodobenzylguanidine scintigraphy (MIBG scan) for accurate staging of neuroblastoma.
A medical record search by the identified patients with neuroblastoma from 1993 to 2012 who underwent both MIBG and bone scan for disease staging. Cross-sectional imaging was used to corroborate the scintigraphy results. Clinical records were used to correlate imaging findings with clinical staging and patient management.
One hundred thirty-two patients underwent both MIBG and bone scan for diagnosis. All stage 1 (n = 12), 2 (n = 8), and 4S (n = 4) patients had a normal bone scan with no skeletal MIBG uptake. Six of 30 stage 3 patients had false (+) bone scans. In the 78 stage 4 patients, 58/78 (74%) were both skeletal MIBG(+)/bone scan (+). In 56 of the 58 cases, skeletal involvement detected with MIBG was equal to or greater than that detected by bone scan. Only 3/78 had (-) skeletal MIBG uptake and (+) bone scans; all 3 had other sites of metastatic disease. Five of 78 had (+) skeletal MIBG with a (-) bone scan, while 12/78 had no skeletal involvement by either MIBG or bone scan. In no case did a positive bone scan alone determine a stage 4 designation.
In the staging of neuroblastoma, Tc-MDP bone scintigraphy does not identify unique sites of disease that affect disease stage or clinical management, and in the majority of cases bone scans can be omitted from the routine neuroblastoma staging algorithm.
神经母细胞瘤的准确分期需要多种影像学检查。本研究的目的是确定锝-亚甲基二膦酸盐（MDP）骨闪烁显像（骨扫描）与间碘苄胍闪烁显像（MIBG扫描）在神经母细胞瘤准确分期中的相对作用。
通过检索1993年至2012年间确诊为神经母细胞瘤且接受MIBG和骨扫描进行疾病分期的患者病历。采用横断面成像来证实闪烁显像结果。利用临床记录将影像学检查结果与临床分期及患者治疗情况相关联。
132例患者接受了MIBG和骨扫描以进行诊断。所有1期（n = 12）、2期（n = 8）和4S期（n = 4）患者的骨扫描均正常，骨骼无MIBG摄取。30例3期患者中有6例骨扫描结果为假阳性。在78例4期患者中，58/78（74%）骨骼MIBG（+）/骨扫描（+）。在这58例中的56例中，MIBG检测到的骨骼受累情况等于或大于骨扫描检测到的情况。78例中只有3例骨骼MIBG摄取（-）但骨扫描（+）；这3例均有其他转移病灶部位。78例中有5例骨骼MIBG（+）但骨扫描（-），而12/78例骨骼MIBG和骨扫描均未显示骨骼受累。在任何情况下，仅骨扫描阳性都不能确定为4期。
在神经母细胞瘤分期中，锝-MDP骨闪烁显像不能识别影响疾病分期或临床治疗的独特病灶部位，并且在大多数情况下，骨扫描可从常规神经母细胞瘤分期算法中省略。
