Evolving Neuroblastoma Imaging: Enhanced Precision with [18F]MFBG PET/CT

Emerging real-world data underscores how advanced tumor imaging modalities such as [18F]MFBG PET/CT are redefining diagnostic precision in pediatric oncology, outpacing somatostatin receptor PET in sensitivity for neuroblastoma detection.

Imaging stands as a cornerstone in neuroblastoma management, yet conventional techniques often leave small lesions undetected, complicating staging and therapeutic planning. In the pivotal study comparing [¹⁸F]MFBG PET/CT and somatostatin receptor PET (SSTR PET), [¹⁸F]MFBG PET/CT unveiled additional metastatic sites in over 20% of patients, translating into markedly higher diagnostic sensitivity and comprehensive staging assessments that redefine PET/CT scan efficacy in pediatric oncology.

This enhanced sensitivity enables clearer delineation of both soft-tissue and skeletal involvement, facilitating stage refinements that influence risk-adapted therapeutic algorithms. Incorporating meta-[¹⁸F]fluorobenzylguanidine ([¹⁸F]MFBG) PET/CT into clinical pathways has enhanced cancer imaging, leading to treatment modifications—intensifying therapy in high-risk cases while sparing lower-risk patients from unnecessary toxicity. However, limitations such as false-positive rates and areas where [¹⁸F]MFBG PET/CT may not outperform existing modalities should be considered.

Recent registry analyses highlight a dual-edged reality: despite the promise of these [¹⁸F]MFBG advancements, access remains constrained by radiochemistry infrastructure, tracer production capacity, and evolving reimbursement frameworks. These practical limitations mirror challenges seen with other new imaging modalities and underscore a need for systemic solutions.

Addressing these barriers will demand coordinated efforts between nuclear medicine departments, radiopharmacy networks, and health policymakers to expand tracer availability and integrate [¹⁸F]MFBG into standard diagnostic imaging for neuroblastoma. Evaluating its cost-effectiveness across diverse practice settings remains a critical priority to ensure that enhanced diagnostic accuracy translates into improved survival outcomes.

Key Takeaways:

• [¹⁸F]MFBG PET/CT offers superior diagnostic precision for neuroblastoma compared to SSTR PET.
• Enhanced imaging allows for more accurate staging and tailored treatment strategies, improving patient outcomes.
• Challenges like cost and access limit the widespread use of [¹⁸F]MFBG PET/CT, prompting a need for systemic solutions.