MIBG

Neuroendocrine Studies

  • Studies as below

  • Used to look at

    • Carcinoid

    • Neuroendocrine tumors including pancreatic neuroendocrine tumors like gastrinoma

    • Pheochromocytoma

    • Paraganglioma

    • Medullary thyroid cancer

DOTATATE

  • Tracer = Ga-68 or F-18 Dotatate

    • Somatostatic analog

  • First line for just about everything except neuroblastoma (MIBG) and insulinoma (GLP-1 receptor imaging)

  • Only test that determines if eligible to receive PRRT

    • Give Lu-177 dotatate to target these receptors and kill shit

I123-MIBG Scan

  • Tracer = I - 123-MIBG

    • Norepi analog

    • T1/2 = 13 hours

      • Can image up to 48 hours

  • Highest sensitive and specificity for neuroblastoma

  • Times you would consider over Dotatate

    • Looking for neuroblastoma

    • High levels of catecholamines

  • Give lugol solution 2 days prior to exam to protect thyroid

In-111 pentetreotide (Octreoscan)

  • Used for

    • Carcinoid tumors

    • Pancreatic islet cell tumors (i.e. gastrinoma)

    • Other tumors that are hot, although less commonly used to evaluate these

      • Meningioma

      • Medullary thyroid cancer

      • Small cell lung cancer

  • When to consider

    • If you want dotatate but PET is not available

  • Images need to be acquired at

    • 4 & 24 hours post injection OR

      • 4 hours because can see activity before bowel has uptake which obscured lesions

    • 24 & 48 hours post injection

      • Used when there is a lot of bowel activity at 24 hours so 48 hour film needed

Neuroblastoma

References: