The Role of 18 F-AlF-NOTA-Octreotide PET/CT in the Evaluation of Central Nervous System Metastases in Neuroblastoma : A Preliminary Study.

Abstract

To assess the role of fluorine-18-Al-1,4,7-triazacyclononane-1,4,7-tri-acetate-octreotide ( 18 F-AlF-NOTA-octreotide) PET/CT in detecting central nervous system (CNS) metastases in neuroblastoma (NB). A retrospective analysis was carried out on 707 18 F-AlF-NOTA-octreotide PET/CT examinations that were performed between January 2021 and July 2024. Reports were screened to identify patients with CNS metastases. Imaging data were then individually reviewed to confirm the presence of 18 F-AlF-NOTA-octreotide-avid lesions. CNS metastatic characteristics, including anatomic site (cerebral parenchyma, leptomeninges, and dura mater), lesion number, and maximum diameter, were systematically documented. A total of 20 children (18 boys and 2 girls; median age, 59 mo) diagnosed with CNS metastases from NB were included. Among them, 5 patients presented with isolated recurrence and 14 patients exhibited asymptomatic disease at the time of detection. A total of 43 CNS metastatic lesions were detected: 22 in the leptomeninges, 13 in the dura mater, and 8 in the cerebral parenchyma. Lesions had a median maximum diameter of 10 mm (interquartile range: 7-13 mm; range: 4-55 mm), with 65% (28/43) measuring ≤10 mm. The overall sensitivity for lesion detection was 93.5%, with 90.3% sensitivity for small lesions (≤10 mm). 18 F-AlF-NOTA-octreotide PET/CT demonstrates exceptional diagnostic sensitivity for detecting CNS metastases in NB, serving as a valuable complementary imaging modality.