Gelfand M J
Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45228-2899.
Semin Nucl Med. 1993 Jul;23(3):231-42. doi: 10.1016/s0001-2998(05)80104-7.
Meta-iodobenzylguanidine (MIBG) is an effective imaging agent for neuroblastoma and pheochromocytoma in children, MIBG is concentrated by the neurosecretory granules of normal and neoplastic tissues of neural crest origin. The typical normal scintigraphic uptake pattern of MIBG includes the salivary glands, lung, myocardium, liver, gastrointestinal tract, and contents of the urinary bladder. When MIBG is labeled with iodine-123 (123I), the adrenal glands often are seen. The sensitivity and specificity of MIBG imaging is extremely high in both neuroblastoma and pheochromocytoma. MIBG may detect extensive bone and bone marrow involvement in neuroblastoma, in the absence of findings on bone marrow aspiration and biopsy, plain radiographs, and bone scintigraphy. MIBG labeled with 131I has been used with moderate success in the palliation of advanced neuroblastoma and pheochromocytoma. Early therapeutic intervention in advanced neuroblastoma is promising. Current controversies in the application of MIBG include (1)131I versus 123I as a label for imaging studies: Although improved image quality and reduced absorbed radiation dose are achieved with [123I]MIBG imaging, is it actually more efficacious in the detection of neuroblastoma? (2) Use of bone scintigraphy in neuroblastoma: Given the small number of false-negative MIBG scans for bone involvement, can the bone scan be dropped as a routine study in the follow-up of neuroblastoma? (3) Other new imaging agents: Is there a role for labeled monoclonal antibodies, somatostatin analogs, and magnetic resonance imaging of marrow in the routine follow-up of neuroblastoma? (4) Iodine-125 MIBG therapy in neuroblastoma: Is the improved energy deposition of 125I at extremely short range useful in the ablation of micrometastases? (5) Early therapy with MIBG in neuroblastoma: Is there a role for MIBG therapy in the initial therapeutic regimens of children with advanced neuroblastoma? Twelve years after the initial report of its use in humans, MIBG has become an important imaging agent in pediatric neural tumors, one that is used routinely and efficaciously in many centers. In the next few years we will continue to learn more about its use, particularly in the therapy of advanced neural crest tumors.
间碘苄胍（MIBG）是一种用于儿童神经母细胞瘤和嗜铬细胞瘤的有效显像剂，MIBG可被神经嵴起源的正常组织和肿瘤组织的神经分泌颗粒摄取。MIBG典型的正常闪烁显像摄取模式包括唾液腺、肺、心肌、肝脏、胃肠道及膀胱内容物。当MIBG用碘-123（123I）标记时，常可见肾上腺。MIBG显像在神经母细胞瘤和嗜铬细胞瘤中的敏感性和特异性都极高。MIBG可在骨髓穿刺活检、X线平片及骨闪烁显像均无异常发现的情况下，检测出神经母细胞瘤广泛的骨骼和骨髓受累情况。用131I标记的MIBG已在晚期神经母细胞瘤和嗜铬细胞瘤的姑息治疗中取得了一定成效。晚期神经母细胞瘤的早期治疗干预前景广阔。目前MIBG应用中的争议包括：（1）131I与123I作为显像研究的标记物：尽管[123I]MIBG显像可提高图像质量并降低吸收辐射剂量，但在神经母细胞瘤的检测中其实际效果是否更佳？（2）神经母细胞瘤中骨闪烁显像的应用：鉴于MIBG扫描对骨受累的假阴性结果较少，在神经母细胞瘤随访中能否放弃骨扫描作为常规检查？（3）其他新型显像剂：标记单克隆抗体、生长抑素类似物及骨髓磁共振成像在神经母细胞瘤的常规随访中是否有作用？（4）碘-125 MIBG治疗神经母细胞瘤：125I在极短距离内改善的能量沉积对微转移灶的消融是否有用？（5）神经母细胞瘤的MIBG早期治疗：MIBG治疗在晚期神经母细胞瘤患儿的初始治疗方案中是否有作用？在首次报道其用于人体12年后，MIBG已成为儿科神经肿瘤的一种重要显像剂，在许多中心被常规且有效地使用。在未来几年，我们将继续深入了解其用途，尤其是在晚期神经嵴肿瘤的治疗方面。
