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.
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PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.