[18F]mFBG PET/CT surpasses [18F]FDG PET/CT for evaluation of pediatric neuroblastoma

Wenqian Zhang; Chao Yang; Zhenzhen Zhao; Shunhao Zhou; Yanyao Han; Chenxi Zheng; Yalan Xiong; Changchun Li; Yao Zhang; Zhenni Wang; Liang Cai; Shan Wang

doi:10.3389/fonc.2025.1627403

[¹⁸F]mFBG PET/CT surpasses [¹⁸F]FDG PET/CT for evaluation of pediatric neuroblastoma

Front Oncol. 2025 Sep 2:15:1627403. doi: 10.3389/fonc.2025.1627403. eCollection 2025.

Authors

Wenqian Zhang^#¹, Chao Yang^#², Zhenzhen Zhao², Shunhao Zhou¹, Yanyao Han¹, Chenxi Zheng¹, Yalan Xiong¹, Changchun Li², Yao Zhang², Zhenni Wang², Liang Cai¹, Shan Wang²

Affiliations

¹ Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Department of Surgical Oncology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.

^# Contributed equally.

Abstract

Purpose: [¹⁸F]FDG PET/CT serves as an alternative imaging modality for neuroblastoma in cases where [¹²³I]MIBG yields negative results or is unavailable. [¹⁸F]mFBG, a novel PET tracer for neuroblastoma imaging, requires further clinical validation. This preliminary study aims to evaluate the efficacy of [¹⁸F]mFBG PET/CT compared to [¹⁸F]FDG PET/CT in detecting neuroblastoma.

Methods: In this retrospective investigation, 56 pediatric patients were enrolled. Each patient underwent both [¹⁸F]mFBG PET/CT and [¹⁸F]FDG PET/CT within one week. Two children underwent a second paired [¹⁸F]FDG-[¹⁸F]mFBG PET/CT scan. In total, 58 paired scans (mean age 47.6 ± 38.0 months, range 6-108 months) were performed. Two experienced readers measured normal organ uptake (SUV_mean), lesion uptake (SUV_max), and tumor-to-background ratio (TBR). A lesion-by-lesion analysis was conducted to compare detection rates between [¹⁸F]mFBG and [¹⁸F]FDG.

Results: Twenty paired scans exhibited negative findings on both [¹⁸F]mFBG and [¹⁸F]FDG studies. Among the remaining 38 scans, 8 (21.05%) were [¹⁸F]mFBG-positive/[¹⁸F]FDG-negative, 1 (2.63%) was [¹⁸F]FDG-positive/[¹⁸F]mFBG-negative, and 29 (76.32%) were positive on both tracers. In these 38 scans, [¹⁸F]mFBG PET/CT identified 431 lesions, whereas [¹⁸F]FDG PET/CT detected only 162 lesions (p<0.001). Six of eight [¹⁸F]mFBG-positive/[¹⁸F]FDG-negative cases were histopathologically confirmed as neuroblastoma. The mean TBR of [¹⁸F]mFBG PET/CT(6.68 ± 5.76) was significantly higher (p<0.001) than that of [¹⁸F]FDG PET/CT (4.49 ± 2.88).

Conclusion: [¹⁸F]mFBG PET/CT detected more neuroblastoma lesions than [¹⁸F]FDG PET/CT, suggesting it may be a more viable alternative when standard [¹²³I]MIBG scanning is not feasible.

Keywords: PET/CT; [18F]FDG; [18F]mFBG; neuroblastoma; norepinephrine transporter.