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.

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.