Failure of MIBG scan to detect metastases in SDHB-mutated pediatric metastatic pheochromocytoma

Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26549. Epub 2017 Apr 14.

Abstract

123 I-meta-iodo benzyl guanidine (MIBG) scans are considered the gold standard imaging in neuroblastoma; however, flouro deoxy glucose positron emission tomography (FDG-PET) scans have increased sensitivity in adults with pheochromocytoma/paraganglioma. We describe a pediatric patient initially considered to have localized neuroblastoma based on anatomical imaging and 123 I-MIBG scan, but subsequent investigations revealed germline succinate dehydrogenase complex iron sulfur subunit B (SDHB) mutation-associated pheochromocytoma with multiple FDG-avid skeletal metastases. We then compared 123 I-MIBG and FDG-PET scans in children with metastatic pheochromocytoma/paraganglioma. FDG-PET was superior to 123 I-MIBG scan for the detection of skeletal metastases (median number of skeletal lesions detected 10 [range 1-30] vs. 2 [range 1-26], respectively; P = 0.005 by t-test). FDG-PET should be considered the functional scan of choice in children with pheochromocytoma/paraganglioma.

Keywords: imaging; metastatic pheochromocytoma; solid tumor.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • 3-Iodobenzylguanidine / metabolism*
  • Adolescent
  • Adrenal Gland Neoplasms / diagnostic imaging
  • Adrenal Gland Neoplasms / genetics
  • Adrenal Gland Neoplasms / metabolism
  • Adrenal Gland Neoplasms / secondary*
  • Female
  • Fluorodeoxyglucose F18 / metabolism
  • Humans
  • Mutation*
  • Paraganglioma / diagnostic imaging
  • Paraganglioma / genetics
  • Paraganglioma / metabolism
  • Paraganglioma / pathology*
  • Pheochromocytoma / diagnostic imaging
  • Pheochromocytoma / genetics
  • Pheochromocytoma / metabolism
  • Pheochromocytoma / pathology*
  • Positron-Emission Tomography / methods
  • Prognosis
  • Radionuclide Imaging / methods
  • Radiopharmaceuticals / metabolism
  • Succinate Dehydrogenase / genetics*

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • 3-Iodobenzylguanidine
  • SDHB protein, human
  • Succinate Dehydrogenase