Nuclear medicine procedures in neuroblastoma

In NB diagnostic setting, nuclear medicine procedures have demonstrated major accuracy for both staging and treatment response assessments, including the evaluation of bone and bone marrow involvement. 123I-MIBG scintigraphy has been extensively used in research and clinical practice for over 35 years, representing the most important functional imaging modality in NB assessment. Furthermore, therapy with 131I-MIBG has been extensively employed in neuroblastoma since the late 1980s, with a systematic review analyzing 1121 patients treated with 131I-MIBG. 131I-MIBG was used as single agent (monotherapy) in patients with a poor prognosis, in particular those with recurrent/refractory disease, as a palliative treatment. So far, 131I-MIBG therapy is included in multicentric trials on high-risk neuroblastoma patients. However, in recent years, different types of “new” PET tracers have been introduced in the diagnostic workup of NB showing very promising results [21, 22]. In this new diagnostic scenario, it seems important to identify strengths and limitation of each different functional diagnostic modality. The aim of this chapter is to analyze, in terms of availability and accuracy, the principal nuclear medicine procedures used in NB. In addition, the prevalent or complementary role of each functional imaging method is highlighted.