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Reprinted with permission from Oxford Medical Publications: Thyroid Cancer and Endocrine Tumors. In: The Management of Advanced Cancer. Eds: N. Cherny, et al, In Press.

Figure 19. Anterior and posterior 111In-pentetreotide images of a patient with a nonfunctioning neuroendocrine tumor with an unknown primary. Metastases are seen in the right supraclavicular fossa and the mediastinum (arrows).

123I-mIBG is the investigation of choice for initial staging, restaging after treatment, assessment of post surgical residual disease (Fig. 21), monitoring treatment response and for the early detection of recurrence on routine follow-up. The sensitivity and specificity of the technique in these settings are in excess of 94% and 95%, respectively. It may be the only indicator of bone marrow involvement where a pattern of diffuse uptake in long bones is characteristically seen (Fig. 22). mIBG uptake in an abdominal mass in a small child is pathognomonic of neuroblastoma and can often speed diagnosis and progress to treatment.

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