The value of 123I-MIBG xSPECT/CT quantitative parameters in the diagnosis of bone metastasis in pediatric neuroblastoma patients.
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BACKGROUND: The diagnostic value of quantitative single-photon emission computed tomography/computed tomography (xSPECT/CT) in the screening of bone metastases of various malignant tumors varies. This study investigated the differential diagnostic value of quantitative parameters of 123I-metaiodobenzylguanidine (123MIBG) xSPECT/CT imaging in the diagnosis of bone metastasis in pediatric neuroblastoma (NB) patients. METHODS: In this retrospective cohort study, the 123I-MIBG xSPECT/CT images of 125 children with NB confirmed by pathology at Beijing Friendship Hospital from March 2022 to December 2023 were assessed. A Spearman correlation analysis was conducted to assess the factors influencing normal bone quantitative parameters, and differences in the standardized uptake values (SUVs), including the maximum standardized uptake value (SUVmax), average standardized uptake value (SUVavg), minimum standardized uptake value (SUVmin), and peak standardized uptake value (SUVpeak), between metastatic bone lesions and normal bone were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values of the SUVs in the diagnosis of metastatic bone lesions. The above indexes were compared via a visual analysis, and using the chi-square test. The clinical parameters and semi-quantitative indexes of xSPECT/CT were also analyzed using univariate and multivariate methods. RESULTS: The study cohort comprised 75 girls and 50 boys with an average age of 5.94 years (0.6-9 years). The SUVs of metastatic bone lesions were significantly higher than those of normal bone (P<0.0001), but there was no statistically significant difference in the SUV values of metastatic bone lesions among the different Curie score subzones (P>0.05). The area under the curve (AUC) values for the SUVmax, SUVavg, SUVmin, and SUVpeak were 0.946 [95% confidence interval (CI): 0.921-0.971], 0.962 (95% CI: 0.939-0.984), 0.953 (95% CI: 0.928-0.978), and 0.959 (95% CI: 0.936-0.982), respectively (P<0.0001). The optimal diagnostic thresholds identified for the SUVmax, SUVavg, SUVmin, and SUVpeak were 0.39, 0.36, 0.19 and 0.35, respectively. The SUVavg was the best index among the different Curie score subzones, and the specificity of the quantitative analysis in diagnosing bone metastasis in NB patients was better than that of the visual analysis. We also showed that tumor stage and neuron specific enolase (NSE) levels are important factors influencing the diagnosis of bone metastasis. There was no statistically significant difference in the SUV values for normal bone among different physical parameters (P>0.05). CONCLUSIONS: A SUVavg above 0.36 g/mL in NB patients had the best efficacy in the diagnosis of bone metastasis in NB patients. Quantitative indexes of xSPECT/CT had better specificity in the diagnosis of bone metastasis in NB patients than the visual analysis. 123I-MIBG xSPECT/CT imaging can increase the diagnostic confidence of bone metastasis in NB.