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Figure 18B. Coronal SPECT images showing the ability of SPECT to better delineate the distribution of tumor within the mediastinum. The arrowhead indicates an apical pulmonary metastasis.

Although several radiopharmaceuticals have been described which show uptake by MTC, mIn-pentetreotide (Octreoscan®) remains the mainstay of nuclear medicine imaging. The role of mIBG is uncertain; although it has very high specificity, sensitivity is reported as 35-50% in most series. Our practice is to use mIBG only for treatment stratification.

mIn-pentetreotide has a reported sensitivity of between 50-80% in small series. If SPECT is performed using higher doses of indium-Ill then accuracy is around 70-75%, especially for detecting mediastinal recurrence or residual tumor in the neck.

111 In-pentetreotide imaging is a valuable addition to anatomic imaging techniques (which have relatively low sensitivity) in patients with a rising calcitonin or CEA, as a post operative evaluation or in patients with symptoms.

Neuroblastoma

Neuroblastoma is the commonest solid tumor of childhood and the fourth commonest pediatric neoplasm. Its incidence is approximately 10 per million. Despite aggressive combination chemotherapy regimes, the outlook remains bleak for those presenting with Stage IV disease. Approximately 50% of younger children and 75% of older children present at this advanced stage.

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