Evaluation of iodine-123-labeled metaiodobenzylguanidine single- photon emission computed tomography/computed tomography based on the International Society of Pediatric Oncology Europe Neuroblastoma score in children with neuroblastoma

Background: This study sought to examine whether iodine-123-labeled metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography/computed tomography (SPECT/CT), which is based on the International Society of Pediatric Oncology Europe Neuroblastoma (SIOPEN) score, could improve the diagnostic efficiency of children with neuroblastoma (NB), and to compare the diagnostic ability of minimal residual disease (MRD) detection and 123I-MIBG SPECT/CT. Methods: We retrospectively analyzed 238 scans of patients who underwent 123I-MIBG SPECT/CT at the Department of Nuclear Medicine, Beijing Friendship Hospital, from January 2021 to December 2021. The diagnostic study was not registered with a clinical trial platform, and the study protocol was not published. The standard was established based on pathology, other relevant imaging examinations, and follow-up. The SIOPEN scores were calculated separately based on planar and tomographic imaging. Results: In a comparison to the standard mentioned in the method, the diagnostic accuracy of planar and tomographic imaging was 151 of 238 (63.5%) and 228 of 238 (95.8%), respectively, and the kappa values of the SIOPEN score were 0.468 and 0.855 (P<0.001), respectively. The SIOPEN scores differed significantly among the various subgroups. The polymerase chain reaction (PCR) method used to detect the bone marrow PHOX2B gene was able to find bone/bone marrow metastases (P=0.024, kappa=0.282), while the flow cytometry (FCM) assay method was not statistically significant (P=0.417, kappa=0.065). Conclusions: 123I-MIBG SPECT/CT, which relies on the semiquantitative assessment of the SIOPEN score, is of clinical importance in the management of pediatric NB. MRD detection can be used to detect early metastasis and recurrence in the bone or bone marrow; however, 123I-MIBG SPECT/CT has better diagnostic value. We intend to conduct further investigations on their prognostic value in the future.