[18F]MFBG PET/CT is an effective and preferable imaging modality for neuroblastoma in a prospective comparison with SSTR PET.
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PURPOSE: [18F]-meta-fluorobenzylguanidine ([18F]MFBG) and somatostatin receptor (SSTR)-targeted PET tracers have both been proposed for imaging neuroblastoma, however, their respective clinical roles remain unclear. This prospective study compared [18F]MFBG PET with SSTR-targeted PET, using either [68Ga]Ga-DOTATATE or [18F]AlF-NOTA-octreotide([18F]-OC), to evaluate diagnostic performance and potential clinical impact in neuroblastoma. METHODS: Sixteen patients (median age 5.0 years, IQR 3.3-5.8 years) with confirmed history of neuroblastoma underwent paired [18F]MFBG and SSTR PET imaging across two centers. Lesion detection rate, Curie scores, and tracer uptake metrics were compared on both a per-patient and per-lesion basis. RESULTS: [18F]MFBG and SSTR PET both identified at least one lesion in all 12 patients with active disease. Four patients had concordant negative scans and were confirmed to be in remission on clinical follow-up (range, 3-13 months). On lesion-based analysis, [18F]MFBG detected 292 lesions, compared to 243 lesions identified by SSTR PET (p = 0.128). Aggregate Curie scores were significantly higher with [18F]MFBG than with SSTR PET (130 vs. 90, p = 0.028). In bone marrow metastases, [18F]MFBG showed slightly lower SUVmax compared to SSTR PET (8.2 ± 7.8 vs. 9.9 ± 6.7, p = 0.176), but yielded a higher tumor-to-background ratio (TBR, 12.6 ± 8.6 vs. 9.1 ± 5.3, p = 0.09). Importantly, no clinically relevant findings were uniquely identified on SSTR PET that altered patient management when [18F]MFBG PET was available. CONCLUSION: In this head-to-head comparison, [18F]MFBG PET/CT demonstrates excellent diagnostic performance in neuroblastoma, comparable to SSTR-targeted PET. These findings suggest that routine dual-tracer imaging is not recommended and should be reserved for patients based on specific therapeutic consideration, including the clinical need for [131I]MIBG radionuclide therapy or peptide receptor radionuclide therapy (PRRT). CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT05069220 (Registered: 25 September 2021, retrospectively registered); Institute Review Board of Peking Union Medical College Hospital: ZS-2514. CLINICALTRIALS: gov: NCT06852807 (Registered: 24 February 2025, retrospectively registered); Institute Review Board of The First Affiliated Hospital of Zhejiang University School of Medicine: [2025 C] IIT No.008.