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Purpose <p>To evaluate and compare the diagnostic performance of fluorine-18-aluminum fluoride-1,4,7-triazacyclononane-1,4,7-triacetic acid-octreotide (<sup>18</sup>F-AlF-NOTATATE) PET/CT and iodine-123 Metaiodobenzylguanidine (<sup>123</sup>I-MIBG) scintigraphy with SPECT/CT in detecting recurrent high-risk neuroblastoma (HR-NB) after complete response (CR), and to evaluate their impact on clinical decision-making.</p> Methods <p>This retrospective study included 68&#xa0;HR-NB patients (67 with confirmed recurrences, 1 without recurrence) who underwent <sup>18</sup>F-AlF-NOTATATE PET/CT and <sup>123</sup>I-MIBG scintigraphy with SPECT/CT within 7 days. Imaging findings were analyzed for sensitivity, lesion patterns, anatomical locations, spatial distribution, and semiquantitative Curie scores. The impact on clinical management was evaluated by comparing actual versus hypothetical treatment decisions. Recurrence was confirmed using a composite reference standard (histopathology or ≥ 6-month of imaging/clinical follow-up).</p> Results <p><sup>18</sup>F-AlF-NOTATATE PET/CT demonstrated numerically higher sensitivity than <sup>123</sup>I-MIBG scintigraphy with SPECT/CT (97.0% vs. 88.2%). The combined use of both modalities achieved 100% sensitivity, a statistically significant improvement over either single modality (<i>p</i> &lt; 0.001). Recurrences predominantly exhibited focal/mixed patterns (94.0%) and distant metastases (82.0%; <i>p</i> &lt; 0.001). <sup>18</sup>F-AlF-NOTATATE PET/CT yielded significantly higher Curie scores (<i>p</i> = 0.002). Clinically, <sup>18</sup>F-AlF-NOTATATE PET/CT influenced therapeutic decisions in 37.5% of cases, versus 5% for <sup>123</sup>I-MIBG scintigraphy with SPECT/CT alone. Combined imaging affected management in 58.8% of cases (72.5% therapeutic shifts).</p> Conclusion <p><sup>18</sup>F-AlF-NOTATATE PET/CT provides critical complementary value to <sup>123</sup>I-MIBG scintigraphy with SPECT/CT. It provides a numerical sensitivity benefit, mitigates MIBG non-avidity limitations, and informs clinical decision-making. The combined use of both imaging modalities achieves 100% sensitivity, supporting the integration of this dual-modality approach into HR-NB surveillance protocols.</p>

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Comparison of Iodine-123 Metaiodobenzylguanidine scintigraphy with SPECT/CT and Fluorine-18-aluminum fluoride-1,4,7-triazacyclononane-1,4,7-triacetic acid-octreotide PET/CT in recurrent High-risk neuroblastoma after complete remission

  • 期刊论文

  • 发表日期：

    2025年12月10日

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  • Siqi Li,
  • Yuxuan Liu,
  • Jun Liu,
  • Baojun Sang,
  • Yanfeng Xu,
  • Xiaorong Sun,
  • Jigang Yang

摘要

Purpose

To evaluate and compare the diagnostic performance of fluorine-18-aluminum fluoride-1,4,7-triazacyclononane-1,4,7-triacetic acid-octreotide (18F-AlF-NOTATATE) PET/CT and iodine-123 Metaiodobenzylguanidine (123I-MIBG) scintigraphy with SPECT/CT in detecting recurrent high-risk neuroblastoma (HR-NB) after complete response (CR), and to evaluate their impact on clinical decision-making.

Methods

This retrospective study included 68 HR-NB patients (67 with confirmed recurrences, 1 without recurrence) who underwent 18F-AlF-NOTATATE PET/CT and 123I-MIBG scintigraphy with SPECT/CT within 7 days. Imaging findings were analyzed for sensitivity, lesion patterns, anatomical locations, spatial distribution, and semiquantitative Curie scores. The impact on clinical management was evaluated by comparing actual versus hypothetical treatment decisions. Recurrence was confirmed using a composite reference standard (histopathology or ≥ 6-month of imaging/clinical follow-up).

Results

18F-AlF-NOTATATE PET/CT demonstrated numerically higher sensitivity than 123I-MIBG scintigraphy with SPECT/CT (97.0% vs. 88.2%). The combined use of both modalities achieved 100% sensitivity, a statistically significant improvement over either single modality (p < 0.001). Recurrences predominantly exhibited focal/mixed patterns (94.0%) and distant metastases (82.0%; p < 0.001). 18F-AlF-NOTATATE PET/CT yielded significantly higher Curie scores (p = 0.002). Clinically, 18F-AlF-NOTATATE PET/CT influenced therapeutic decisions in 37.5% of cases, versus 5% for 123I-MIBG scintigraphy with SPECT/CT alone. Combined imaging affected management in 58.8% of cases (72.5% therapeutic shifts).

Conclusion

18F-AlF-NOTATATE PET/CT provides critical complementary value to 123I-MIBG scintigraphy with SPECT/CT. It provides a numerical sensitivity benefit, mitigates MIBG non-avidity limitations, and informs clinical decision-making. The combined use of both imaging modalities achieves 100% sensitivity, supporting the integration of this dual-modality approach into HR-NB surveillance protocols.