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Roopal A, Gaurav M. Unusual Renal Uptake of 131 I-MIBG in a Young Hypertensive With Renal Artery Stenosis. Clin Nucl Med 2024; 49:e370-e372. [PMID: 38537216 DOI: 10.1097/rlu.0000000000005188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ABSTRACT A 10-year-old hypertensive girl underwent 131 I-MIBG scan to rule out neural crest derived tumor. The whole-body images revealed diffuse intense tracer uptake in the right kidney, which persisted in 96-hour images as well. CT renal angiography revealed 90% to 95% right renal artery stenosis. Thereafter, she underwent baseline and angiotensin receptor blockade renal dynamic imaging, which revealed hemodynamically significant renal artery stenosis. Pattern of diffuse and intense 131 I-MIBG uptake, albeit rare, still warrants further evaluation to rule out renal artery stenosis and investigate its hemodynamic significance for appropriate management.
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Affiliation(s)
- Agrawal Roopal
- From the Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, India
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Does the Incremental Value of 123I-Metaiodobenzylguanidine SPECT/CT over Planar Imaging Justify the Increase in Radiation Exposure? Nucl Med Mol Imaging 2021; 55:173-180. [PMID: 34422127 DOI: 10.1007/s13139-021-00707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose Planar scintigraphy with 123I-radiolabeled metaiodobenzylguanidine (123I-mIBG) is an important imaging modality to evaluate neuroblastoma. In recent years, Single Photon Emission Computed Tomography combined with Computed Tomography (SPECT/CT) has revolutionized nuclear medicine. Nevertheless, the addition of the CT has increased the patients' irradiation. We aimed to evaluate the incremental benefits of 123I-mIBG SPECT/CT over conventional planar imaging and to estimate the relative increase of radiation dose. Methods We retrospectively evaluated the added value of 56 SPECT/CT performed in 40 children in terms of better characterization of the lesion and its locoregional extension, better lymph node staging, detection of new lesions, and elimination of false positives by a paired comparison between the planar images and the SPECT/CT ones. Then, we calculated the percentage contribution of the additional radiation of the CT in this hybrid imagery. Results In 88% (49 out of 56) of the examinations, SPECT/CT provided additional information, which was crucial in 20% of the cases. It allowed a better characterization of the lesion and its locoregional extension in 44 cases, a better lymph node staging in 28 cases, the detection of 33 new lesions, and the elimination of 9 false positives. The CT effective dose was significantly lower than the SPECT one. The average additional radiation exposure due to CT was 12% (4-23%). Conclusion 123I-mIBG SPECT/CT has an undeniable added value that improves planar imaging interpretation and impacts patient management. These potential benefits would justify the low additional radiation induced by the CT.
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Abstract
A 6-year-old girl with high-risk neuroblastoma underwent a I-MIBG scan to monitor the disease status. In addition to the known lesion in the right retroperitoneal region, there were additional foci of increased activity in the right upper quadrate of the abdomen, which were not typical bowel activity. SPECT/CT images located the activity in the cortex of the lower pole of the right kidney, which was partially calcified. Subsequent biopsy confirmed neuroblastoma metastasis to the right kidney, which is extremely rare.
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Scolozzi V, Perotti G, Gambaro G, Celi G, Giordano A. Captación renal difusa de 123I-MIBG en un paciente con estenosis severa de la arteria renal: una consecuencia de la activación adrenérgica. Rev Esp Med Nucl Imagen Mol 2019; 38:247-249. [DOI: 10.1016/j.remn.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/12/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
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Scolozzi V, Perotti G, Gambaro G, Celi G, Giordano A. Diffuse 123I-MIBG renal uptake in a patient with severe renal artery stenosis: a consequence of adrenergic activation. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Nuclear medicine has a central role in the diagnosis, staging, response assessment and long-term follow-up of neuroblastoma, the most common solid extracranial tumour in children. These EANM guidelines include updated information on 123I-mIBG, the most common study in nuclear medicine for the evaluation of neuroblastoma, and on PET/CT imaging with 18F-FDG, 18F-DOPA and 68Ga-DOTA peptides. These PET/CT studies are increasingly employed in clinical practice. Indications, advantages and limitations are presented along with recommendations on study protocols, interpretation of findings and reporting results.
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Yeh R, Mohammed A, Margolin A, Schlossberg P, Ayyala RS. Abnormal renal parenchyma accumulation of 123I MIBG in a child with renal artery stenosis. Clin Imaging 2017; 46:20-23. [PMID: 28688242 DOI: 10.1016/j.clinimag.2017.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022]
Abstract
Hypertension is rare in the pediatric population, however renal artery stenosis (RAS) is an important cause that can be difficult to diagnose. Doppler ultrasound is the first line imaging modality, with computed tomography and magnetic resonance imaging as adjunct modalities, all with variable sensitivity for RAS. The gold standard for evaluation of RAS is invasive selective catheter angiography. We present a unique multimodality case of abnormal radiotracer uptake in the renal parenchyma on 123-Iodine metaiodobenzylguanidine (123I MIBG) scan in a patient with unilateral RAS. RAS is a potential cause of a false positive MIBG scan, and proper recognition may lead to accurate diagnosis.
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Affiliation(s)
- Randy Yeh
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States.
| | - Ahmed Mohammed
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Aleksandr Margolin
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Peter Schlossberg
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Rama S Ayyala
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
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Sharp SE, Trout AT, Weiss BD, Gelfand MJ. MIBG in Neuroblastoma Diagnostic Imaging and Therapy. Radiographics 2016; 36:258-78. [PMID: 26761540 DOI: 10.1148/rg.2016150099] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neuroblastoma is a common malignancy observed in infants and young children. It has a varied prognosis, ranging from spontaneous regression to aggressive metastatic tumors with fatal outcomes despite multimodality therapy. Patients are divided into risk groups on the basis of age, stage, and biologic tumor factors. Multiple clinical and imaging tests are needed for accurate patient assessment. Iodine 123 ((123)I) metaiodobenzylguanidine (MIBG) is the first-line functional imaging agent used in neuroblastoma imaging. MIBG uptake is seen in 90% of neuroblastomas, identifying both the primary tumor and sites of metastatic disease. The addition of single photon emission computed tomography (SPECT) and SPECT/computed tomography to (123)I-MIBG planar images can improve identification and characterization of sites of uptake. During scan interpretation, use of MIBG semiquantitative scoring systems improves description of disease extent and distribution and may be helpful in defining prognosis. Therapeutic use of MIBG labeled with iodine 131 ((131)I) is being investigated as part of research trials, both as a single agent and in conjunction with other therapies. (131)I-MIBG therapy has been studied in patients with newly diagnosed neuroblastoma and those with relapsed disease. Development and implementation of an institutional (131)I-MIBG therapy research program requires extensive preparation with a focus on radiation protection.
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Affiliation(s)
- Susan E Sharp
- From the Department of Radiology (S.E.S., A.T.T., M.J.G.) and Department of Pediatrics, Division of Oncology (B.D.W.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3039
| | - Andrew T Trout
- From the Department of Radiology (S.E.S., A.T.T., M.J.G.) and Department of Pediatrics, Division of Oncology (B.D.W.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3039
| | - Brian D Weiss
- From the Department of Radiology (S.E.S., A.T.T., M.J.G.) and Department of Pediatrics, Division of Oncology (B.D.W.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3039
| | - Michael J Gelfand
- From the Department of Radiology (S.E.S., A.T.T., M.J.G.) and Department of Pediatrics, Division of Oncology (B.D.W.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3039
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Diffuse Elevated MIBG Activity in the Renal Parenchyma Caused by Compromised Renal Blood Flow. Clin Nucl Med 2014; 39:1005-8. [PMID: 24999702 DOI: 10.1097/rlu.0000000000000513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
We describe a patient with labile hypertension and elevated metanephrines who underwent 123Iodine metaiodobenzylguanidine (MIBG) for the detection of a possible paraganglioma. The scan revealed markedly abnormal diffusely increased activity in the right renal parenchyma. A CT angiogram showed severe renal artery stenosis of an atrophic-appearing right kidney and delayed enhancement of the right kidney, consistent with renal dysfunction due to renal artery stenosis.
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Acharya J, Chang PT, Gerard P. Abnormal MIBG uptake in a neuroblastoma patient with right upper lobe atelectasis. Pediatr Radiol 2012; 42:1259-62. [PMID: 22618629 DOI: 10.1007/s00247-012-2413-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/27/2012] [Accepted: 03/30/2012] [Indexed: 11/29/2022]
Abstract
A 3-month-old boy with a history of an abdominopelvic neuroblastoma presented 1 week after tumor resection for a routine follow-up 123-I Meta-iodobenzylguanidine (MIBG) scan to assess for residual mass. The study demonstrated abnormal radiotracer uptake in the right upper lobe, which correlated on the SPECT/CT to an area of airspace consolidation thought to be secondary to atelectasis. To the best of our knowledge, there is one published case of MIBG radiotracer uptake in the lung correlating with pneumonia; however, there are no reported cases to date in the literature of focal pulmonary MIBG uptake corresponding to atelectasis.
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Affiliation(s)
- Jay Acharya
- Department of Radiology, Westchester Medical Center, 100 Woods Road, Valhall, NY 10595, USA
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Satharasinghe K, Trahair TN, Barbaric D, O'Brien TA, Russell SJ, Cohn RJ, Marshall GM, Ziegler DS. False-positive MIBG scans with normal computed tomography imaging in patients with high-risk neuroblastoma. J Clin Oncol 2009; 27:e233-4; author reply e235. [PMID: 19884537 DOI: 10.1200/jco.2009.24.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moralidis E, Arsos G, Papakonstantinou E, Badouraki M, Koliouskas D, Karakatsanis C. 123I-Metaiodobenzylguanidine accumulation in a urinoma and cortex of an obstructed kidney after surgical resection of an abdominal neuroblastoma. Pediatr Radiol 2008; 38:118-21. [PMID: 17909780 DOI: 10.1007/s00247-007-0628-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 07/27/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
Abstract
Surgical ureteric injury is rare and often unsuspected for a long time. We present a child in whom an abdominal neuroblastoma was completely excised, but during surgery the left ureter was transected and anastomosed. One month later, during postoperative disease staging, abnormal (123)I-MIBG accumulation was observed in the left renal cortex and the left side of the abdomen. These findings were consistent with acute total obstruction and urinoma formation and were subsequently confirmed by renography and MRI. Despite treatment efforts, a significant amount of left renal mass and function were lost over the following months. These unusual findings are new additions to the literature regarding potential false-positive interpretations of (123)I-MIBG scans.
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Affiliation(s)
- Efstratios Moralidis
- Department of Nuclear Medicine, Aristotelian University, Hippokration Hospital, Thessaloniki, Greece.
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Padberg BC, Rordorf T, Suter SL, Pfeiffer D, Wild D, Schröder S. 123I-Methyljodbenzylguanidin- (MIBG-) Szintigraphie. DER PATHOLOGE 2007; 28:281-4. [PMID: 16673076 DOI: 10.1007/s00292-006-0832-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
(123)I-metaiodobenzylguanidine (MIBG), a radio-labeled catecholamine analogue, is used for the imaging of pheochromocytoma based on the selective uptake of MIBG by chromaffin tissues. MIBG scintigraphy displays high sensitivity (90%) and specificity (close to 100%). In contrast, the false-positive uptake of MIBG by adrenal cortical carcinoma is rare. Here, we report a metastatic oncocytic adrenal cortical carcinoma with MIBG uptake used for therapeutic purposes.
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Affiliation(s)
- B-C Padberg
- Institut für Klinische Pathologie, Universitätsspital, Schmelzbergstrasse 12, 8091, Zürich, Schweiz.
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Kaye J, Hayward M. Soft tissue uptake on 99mTc methylene diphosphonate bone scan imaging: pictorial review. AUSTRALASIAN RADIOLOGY 2002; 46:13-21. [PMID: 11966582 DOI: 10.1046/j.1440-1673.2001.00989.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
99mTechnetium methylene diphosphonate (MDP) bone isotope may accumulate in many extra-osseous sites due to a variety of both benign and malignant conditions. This finding on a bone scan can be crucial to the diagnosis and may not be apparent in other imaging or the clinical evaluation of the patient. We present a pictorial review sampling some of the many causes of extra-osseous 99mTc MDP accumulation.
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Affiliation(s)
- J Kaye
- Medical Imaging Department, Women's & Children's Hospital, North Adelaide, South Australia, Australia
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Cortés-Blanco A, Martínez-Lázaro R, Martínez-Duncker C. Unusual diffuse [(131)I]MIBG accumulation in a kidney with renal artery stenosis. Nephrol Dial Transplant 2000; 15:1885-6. [PMID: 11071986 DOI: 10.1093/ndt/15.11.1885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Cortés-Blanco
- Departamento de Medicina Nuclear Molecular, Hospital Infantil de México Federico Gómez, México DF, México
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Letizia C, De Toma G, Massa R, Corsi A, Caliumi C, Subioli S, D'Erasmo E. False-positive diagnosis of adrenal pheochromocytoma on iodine-123-MIBG scan. J Endocrinol Invest 1998; 21:779-83. [PMID: 9972680 DOI: 10.1007/bf03348046] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
1-123 metaiodobenzylguanidine (1-123 MIBG) scintigraphy is known for its high specificity in detecting pheochromocytoma and other tumors of neural crest origin. In this rare case report, we describe a definite adrenocortical adenoma that demonstrated false-positive uptake at I-123 MIBG scintigraphy and a remarkable accumulation of 75-SE-6-beta-selenomethyl-norcholesterol.
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Affiliation(s)
- C Letizia
- Istituto di 2a Clinica Medica, Università degli Studi di Roma, La Sapienza, Italy
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