Claudiani F, Stimamiglio P, Bertolazzi L, Cabria M, Conte M, Villavecchia G P, Garaventa A, Lanino E, De Bernardi B, Scopinaro G
Nuclear Medicine Service, Galliera Hospital, Genoa, Italy.
Q J Nucl Med. 1995 Dec;39(4 Suppl 1):21-4.
In a group of 97 patients aged from 6 months to 12 years, all with suspected or proven neural crest tumours, metaiodobenzylguanidine (MIBG) scintigraphy was performed at the time of diagnosis and, in some instances, after induction chemotherapy. All the patients underwent a tumour biopsy with cytological and histological analysis, in addition to imaging examinations such as X-rays, ultrasound, computed tomography and magnetic resonance, within a short period before or after scintigraphy. In 82 of 97 cases MIBG was effective in detecting the primary tumour, hence the technique's sensitivity was 84%. A significant different of sensitivity between [131I]MIBG and [123I]MIBG was not demonstrated. As regards metastatic locations, MIBG scans revealed one or more bone metastases in 12 cases, bone marrow involvement (assumed to be present when diffuse and symmetric uptake in the spine, pelvis and possibly other skeletal sites were visualized) in 9 cases, and focal liver metastases or hepatomegaly in 4 cases. Probably owing to the restrictive diagnostic criterion adopted or to the early phase of the bone marrow involvement, the last was found by biopsy but missed by MIBG in 25 cases. The overall sensitivity in detecting metastases was low (48%), but it was much higher if only bone metastases were considered (81%). Twenty-nine patients who had positive scans at diagnosis were checked following 1-2 courses of induction chemotherapy (IC). MIBG scans remained positive in 22 primary tumours, while 7 primary masses were no longer detected. Out of 12 cases showing metastases at diagnosis, two cases with liver lesions became normal and in one case some, but not all, of the bone lesions were not detectable; 4 cases remained abnormal, while in 5 cases bone marrow involvement was not confirmed. Three cases were confirmed to be true negatives; in 4 other cases bone marrow involved not showing at diagnosis was revealed and confirmed by biopsy; 3 cases in which bone marrow involvement was not revealed by MIBG at diagnosis, had normal MIBG and biopsy results after IC; finally, 2 false negative bone marrow cases and 5 true negative cases at diagnosis remained unchanged, but were not checked by biopsy. Performing total body MIBG scintigraphy in childhood neuroblastoma at diagnosis is useful: 1) to predict the nature of the masses detected by other imaging techniques, when biopsy has not yet been performed; 2) for more accurate tumour staging, in addition to standard imaging investigations, MDP scintigraphy and bone marrow aspiration biopsy, thanks to its ability to detect metastatic lesions; 3) to anticipate the decrease in sensitivity of the technique in detecting both the primary mass and the metastases following induction chemotherapy.
在一组97例年龄从6个月至12岁、均怀疑或确诊患有神经嵴肿瘤的患者中，在诊断时以及某些情况下在诱导化疗后进行了间碘苄胍（MIBG）闪烁扫描。所有患者在闪烁扫描前后短时间内除了接受X线、超声、计算机断层扫描和磁共振等影像学检查外，还进行了肿瘤活检及细胞学和组织学分析。97例中有82例MIBG对检测原发肿瘤有效，因此该技术的敏感性为84%。未证实[131I]MIBG和[123I]MIBG之间的敏感性有显著差异。关于转移部位，MIBG扫描显示12例有一处或多处骨转移，9例有骨髓受累（当在脊柱、骨盆及可能的其他骨骼部位出现弥漫性和对称性摄取时推测存在骨髓受累），4例有局灶性肝转移或肝肿大。可能由于所采用的诊断标准受限或骨髓受累处于早期阶段，最后有25例骨髓受累通过活检发现但MIBG漏诊。检测转移灶的总体敏感性较低（48%），但如果仅考虑骨转移则敏感性要高得多（81%）。29例诊断时扫描阳性的患者在接受1 - 2个疗程的诱导化疗（IC）后接受检查。MIBG扫描显示22例原发肿瘤仍为阳性，而7例原发肿块未再检测到。诊断时有转移的12例中，2例肝脏病变的患者变为正常状态，1例部分（而非全部）骨病变未被检测到；4例仍异常，5例骨髓受累未得到证实。3例被确认为真阴性；4例诊断时未显示骨髓受累但活检发现并证实有骨髓受累；3例诊断时MIBG未显示骨髓受累，诱导化疗后MIBG和活检结果均正常；最后，2例假阴性骨髓病例和5例诊断时的真阴性病例未改变，但未进行活检检查。在儿童神经母细胞瘤诊断时进行全身MIBG闪烁扫描是有用的：1）在尚未进行活检时预测其他影像学技术检测到的肿块的性质；2）除了标准影像学检查、MDP闪烁扫描和骨髓穿刺活检外，由于其检测转移灶的能力，可进行更准确的肿瘤分期；3）预测诱导化疗后该技术在检测原发肿块和转移灶方面敏感性的降低。
