48
children with neuroblastoma under 18 years of age, who underwent either or both
of these scanning procedures as adjuncts to their other diagnostic studies.
They found that the sensitivity of^123 I MIBG varied from 67 to 100% in patients
with neuroblastoma. Thus, false negative findings occurred in as many as 33% of
patients with neuroblastoma; this could result in under-estimating the severity and
prognosis of patients and exposing them to inadequate treatment. Whether^18 F-FDG
PET scans would identify disease in these^123 I-MIBG lesions was not addressed in
any of the studies, and whether higher doses of the radioisotope would identify
these lesions was also not addressed. Another potential limitation is lower ability to
detect CNS metastases [ 17 ]. In contrast, there were exceedingly few false positive
findings, which would have wrongly classified a patient as having metastatic dis-
ease, when they didn’t and thereby subject the patient to excessive therapy.
(^123) I MIBG scanning may be inaccurate in the presence of interfering drugs
including opioids, tricyclic antidepressants, sympathomimetics, anti-hypertensives,
and some anti-psychotics. For children, these medications should be discontinued at
least several days prior to the procedure, as possible. Alternatively, another type of
scan may be preferred.
The side effects of MIBI scanning include; thyroid ablation, pancytopenia,
thrombocytopenia, leukopenia and secondary hematologic malignancies [ 18 , 19 ].
Non-hematologic toxicities include nausea, vomiting, seizures, allergic reactions,
and increased risk of veno-occlusive disease in patients who subsequent undergo
stem cell transplantation.
References
- Hollingsworth CL, Frush DP, Kurtzburg J, Prasad VK. Pediatric hematopoietic stem cell trans-
plantation and the role of imaging. Radiology. 2008;248(2):348–65. doi:10.1148/
radiol.2482070988. - Levine DS, Navarro OM, Chaudry G, Doyle JJ, Blaser SI. Imaging the complications of
bone marrow transplantation in children. Radiographics. 2007;27(2):307–24. doi:10.1148/
rg.272065088. - Coy DL, Ormazabal A, Godwin JD, Lalani T. Imaging evaluation of pulmonary and abdominal
complications following hematopoietic stem cell transplantation. Radiographics.
2005;25(2):305–18. doi:10.1148/rg.252045037. - Campo LD, León NG, Palacios DC, Lagana C, Tagarro D. Abdominal complications follow-
ing hematopoietic stem cell transplantation. Radiographics. 2005;25(2):396–412. doi:10.1148/
rg.342135046. - Seth R, Puri K, Singh P, Selvam P, Rakesh K. The role of fluorodeoxyglucose positron emis-
sion tomography-computerized tomography in resolving therapeutic dilemmas in pediatric
Hodgkin lymphoma. Indian J Nucl Med. 2012; 27(3):141–4. doi:10.4103/0972-3919.112717. - Dierickx D, Tousseyn T, Requilé A, et al. The accuracy of positron emission tomography in the
detection of posttransplant lymphoproliferative disorder. Haematologica. 2012;98(5):771–5.
doi:10.3324/haematol.2012.074500. - Hamadani M, Craig M, Awan FT, Devine SM. How we approach patient evaluation for hema-
topoietic stem cell transplantation. Bone Marrow Transplant. 2010;45:1259–68. doi:10.1038/
bmt.2010.94.
M. Atiq et al.