Superior lesion detection with F-AlF-NOTA-octreotide PET/CT compared to I-MIBG SPECT/CT in neuroblastoma.

Background: High-risk neuroblastoma (NB) is characterized by its resistance to treatment and high recurrence rate. Accurate imaging diagnostic methods can improve prognosis. As an emerging and promising diagnostic tool, the comparative diagnostic value of F-AlF-NOTA-octreotide (F-OC) positron emission tomography/computed tomography (PET/CT) versus the existing I-meta-iodobenzylguanide (I-MIBG) single-photon emission computed tomography/computed tomography (SPECT/CT) in assessing treatment response and monitoring recurrence of NB requires further investigation. The aim of this study is to evaluate the diagnostic value of using F-OC PET/CT compared to I-MIBG SPECT/CT in assessing the therapeutic efficacy and monitoring recurrence of NB in children.

Methods: This retrospective study included 832 pediatric patients presenting with suspected recurrent NB between January 2021 and February 2024. The lesion detection capabilities of I-MIBG SPECT/CT and/or F-OC PET/CT were compared at both patient and lesion levels. McNemar's test and the paired -test were performed to analyze the discrepancies and concordance between the two imaging techniques.

Results: The study population comprised 74 pediatric patients diagnosed with and treated for recurrent NB. The I-MIBG SPECT/CT and/or F-OC PET/CT imaging detected 1,009 positive lesions in 51 of the patients. At the patient level, the lesion detection rates for the two imaging modalities were statistically comparable (P>0.05). At the lesion level, F-OC PET/CT showed significantly higher detection rates for overall lesions and metastases of the bone (which is the primary metastatic site) than I-MIBG SPECT/CT (95.6% 56.6%, 96.4% 56.6%, McNemar's P<0.01). F-OC PET/CT demonstrated superior detection rates compared to I-MIBG SPECT/CT for primary lesions, soft tissue metastases, and lymph node metastases (85.7% 71.4%, 76.5% 64.7%, and 89.8% 52.5%, respectively). However, the observed differences were statistically insignificant (McNemar's P>0.05).

Conclusions: The F-OC PET/CT demonstrates superior lesion detection for pediatric patients diagnosed with NB over I-MIBG SPECT/CT, especially for bone metastases.