Superiority of SPECT/CT over planar ¹²³I-mIBG images in neuroblastoma patients with impact on Curie and SIOPEN score values

Summary

Objective: The existing most common semi-quantitative systems used for neuroblastoma diagnosis include Curie and SIOPEN scores, which are based on ¹²³I-MIBG planar scans. The purpose of our study was to find out whether a statistically significant difference exists in evaluation based on planar and SPECT/CT scans. We also compared the Curie and SIOPEN methods in terms of their use in regular practice. Patients; method: 45 patients aged 0-10 years; 213 assessments were done in total, and the Curie and SIOPEN scores were determined in each case based on planar and SPECT/CT scans. Student’s T-test and the Bland-Altman plot were used for the statistical analysis. Results: Both methods demonstrated a statistically significant difference (p < 0.0001) between planar and SPECT/CT evaluation. In the group of 35 patients with neuroblastoma in clinical stages 3 and 4, in 54% of the patients SPECT/CT detected a lesion that was not visible in the planar scan. In 89% of cases, the lesion was confirmed by another imaging method (CT, MRI). In the group of 10 patients in the clinical stage 1, a difference between planar and SPECT/CT scanning was found only in one patient (10%). In the whole set, 25% patients showed a pathological finding only in soft tissues. Conclusion: We recommend to perform semiquantitative evaluation of neuroblastoma based on SPECT/CT scans, particularly in patients in clinical stages 3 and 4. It is advisable to include soft tissues in the score assessment, as well, given that only soft tissues may be involved in up to 25%

Zusammenfassung

Ziel: Zu den für die Diagnose des Neuroblastoms am häufigsten verwendeten semiquantitativen Systemen zählen die Curie- und SIOPEN-Scores basierend auf planaren ¹²³I-MIBG-Scans. Mit unserer Studie wollten wir herausfinden, ob bei der Bewertung anhand von planaren vs. SPECT/CT-Aufnahmen statistisch signifikante Unterschiede bestehen. Außerdem haben wir die Curie- und SIOPEN- Methode bezüglich ihrer praktischen Anwendung verglichen. Patienten; Methode: 45 Patienten, Alter 0–10 Jahre; insgesamt 213 Untersuchungen, für jeden Fall wurden anhand der planaren und der SPECT/CT Aufnahmen die Curie- und SIOPEN-Scores ermittelt. Die statistische Auswertung erfolgte mittels t-Test und Bland-Altman-Diagramm. Ergebnisse: Mit beiden Methoden ergaben sich statistisch signifikante Unterschiede (p < 0,0001) zwischen der planaren und der SPECT/CT Beurteilung. In der Gruppe der 35 Neuroblastom-Patienten im klinischen Stadium 3 und 4 deckte die SPECT/CT bei 54% der Fälle eine Läsion auf, die im planaren Scan nicht sichtbar war. In 89% der Fälle wurde die Läsion mit anderen bildgebenden Verfahren (CT, MRT) bestätigt. Bei den 10 Patienten im Stadium 1 fanden wir nur bei einem Patienten (10%) einen Unterschied zwischen planarer und SPEDT/CT-Aufnahme. Im Gesamtkollektiv wiesen 25% der Patienten nur im Weichteilgewebe pathologische Befunde auf. Schlussfolgerung: Wir empfehlen die semiquantitative Beurteilung des Neuroblastoms anhand von SPECT/CT-Scans, besonders bei Patienten im klinischen Stadium 3 und 4. Es empfiehlt sich, auch das Weichteilgewebe in das Scoring einzubeziehen, da in bis zu 25% der Fälle ausschließlich dieses betroffen ist.

Keywords

Neuroblastoma - ¹²³I-MIBG scintigraphy - ¹²³I-MIBG semiquantitative scoring - Curie scoring - SIOPEN scoring

Schlüsselwörter

Neuroblastom - ¹²³I-MIBG-Szintigraphie - semiquantitatives ¹²³I-MIBG Scoring - Curie-Scoring - SIOPEN-Scoring

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