Purpose or Case Report: This educational exhibit provides an overview of the role radiotracers play in diagnosing, staging, and treating neuroblastoma and neuroendocrine tumors (NETs) in pediatric patients, particularly those associated with certain cancer predisposition syndromes (CPS), which are linked to an increased incidence of neuroendocrine tumors, including pheochromocytoma, and paraganglioma (PPGL).
Methods & Materials: Objectives include: reviewing the mechanisms of action for key radiotracers: 68Ga-DOTATATE, 123I-MIBG, 18F-FDG, and 18F-MFBG; examining clinical indications and use of each radiotracer in pediatric patients with neuroblastoma and NETs; presenting imaging examples using these radiotracers; discussing the advantages of 18F-MFBG as a potential replacement for 123I-MIBG; exploring the therapeutic role of 131I-MIBG.
Results: Findings highlight: 68Ga-DOTATATE targets somatostatin receptor subtype 2 (SSTR-2) and is FDA-approved for pediatric use; it demonstrates superior sensitivity in detecting metastatic neuroblastoma compared to 123I-MIBG and is preferred for evaluating well-differentiated neuroendocrine tumors in PPGL syndromes, with sensitivity rates between 72% and 100% for PPGLs; advantages include a lower radiation dose than 123I-MIBG and 18F-FDG. 18F-MFBG, a promising alternative to 123I-MIBG, offers improved detection rates and higher tumor-to-background ratios, making it suitable for neuroblastoma and PPGLs. 123I-MIBG, the current standard for staging neuroblastoma, targets norepinephrine transport receptors and is crucial for treatment planning in MIBG-avid tumors; although it has lower sensitivity for PPGLs than 68Ga-DOTATATE, it remains important for evaluating candidates for 131I-MIBG therapy. 18F-FDG, a glucose analog, is useful for identifying metabolically active lesions, especially in aggressive tumors; it serves as a secondary option for non-MIBG-avid neuroblastoma cases and aids in PPGL detection when findings are unclear.
Conclusions: This educational exhibit emphasizes that nuclear medicine is essential in managing neuroblastoma and pediatric NETs. Recent advancements in radiotracers, particularly the approval of 68Ga-DOTATATE and the emerging use of 18F-MFBG, enhance diagnostic accuracy while reducing radiation exposure, significantly improving care and outcomes for children with these tumors.