A head-to-head prospective comparative analysis of ⁶⁸Ga-DOTATATE PET/CT and ¹²³I-MIBG SPECT/CT in central nervous system metastases of neuroblastoma and ganglioneuroblastoma.

Abstract

To assess and compare the diagnostic performance of Gallium-68 DOTA-Tyr³-octreotate positron emission tomography/computed tomography (⁶⁸Ga-DOTATATE PET/CT) and Iodine-123 metaiodobenzylguanidine single photon emission computed tomography/computed tomography (¹²³I-MIBG SPECT/CT) in detecting central nervous system (CNS) metastases of neuroblastoma (NB) and ganglioneuroblastoma (GNB), as well as to evaluate their impact on therapeutic management. This prospective study enrolled 41 patients with NB and GNB who were suspected of having CNS metastases. All patients underwent paired ¹²³I-MIBG SPECT/CT and ⁶⁸Ga-DOTATATE PET/CT imaging within 1 week (median: 3 days; range: 1-7 days). The diagnostic performance of the two imaging modalities was assessed and compared on a per-patient, per-lesion and per-region basis. Furthermore, the differences in patient characteristics between groups with and without changes in clinical management decisions were analyzed. Group differences were evaluated using the independent samples t-test, χ² test, Fisher's exact test, and Mann-Whitney U test. 40 patients (40/41, 98%) were confirmed with CNS metastases. The mean age at CNS metastases was 63 months (range: 8-122 months). ⁶⁸Ga-DOTATATE PET/CT exhibited superior performance compared with ¹²³I-MIBG SPECT/CT in detecting CNS metastases on a per-patient, per-lesion and per-region basis. Additionally, the results of ⁶⁸Ga-DOTATATE PET/CT led to changes in clinical management in 51% (21/41) of patients, primarily due to new or unexpected findings compared with those obtained using ¹²³I-MIBG SPECT/CT. ⁶⁸Ga-DOTATATE PET/CT demonstrated excellent diagnostic performance in NB and GNB patients with CNS metastases. Moreover, the findings from ⁶⁸Ga-DOTATATE PET/CT led to a modification of the therapeutic management in 51% of patients.