123I-labeled metaiodobenzylguanidine for diagnosis of neuroendocrine tumors
Lei Jiang1,2, Meike L Schipper1, Peiyong Li2, Zhen Cheng1
1Molecular Imaging Program at Stanford (MIPS), Departments of Radiology and Bioengineering, Bio-X Program, Stanford University, Stanford, CA, USA; 2Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
Abstract: Metaiodobenzylguanidine (MIBG) is an analog of the catecholamine norepinephrine. Through a type I energy-dependent active amine transport mechanism, it is taken up in presynaptic cytoplasmic storage vesicles of adrenergic nerves. Many normal tissues that have rich adrenergic innervation accumulate MIBG, including the heart and salivary glands. Additionally, MIBG is accumulated in benign and malignant tissues derived from the neural crest, such as the adrenal medulla and neuroendocrine tumors (NETs), where it is stored within neurosecretory granules. This provides the molecular basis for highly specific imaging and therapy with radiolabeled MIBG. Both 123I-MIBG and 131I-MIBG are available for diagnostic purposes. Considering the physical characteristics of 123I (159 keV photon energy, 13.2 hours half-life) and clinical experience, 123I-MIBG is the agent of choice for diagnostic imaging. It shows high sensitivity and specificity in detecting NETs. NETs include a wide range of neoplasms arising from tissues derived from the neural crest, such as neuroblastomas (NBs), pheochromocytomas, paragangliomas, NETs of the gastroenteropancreatic tract (GEP tumors), as well as medullary thyroid carcinomas (MTCs). The purpose of this review is to summarize the diagnostic application of 123I-MIBG in detecting diverse NETs and in guiding the subsequent clinical management and treatment protocols.
Keywords: 123I-MIBG, diagnosis, neuroblastoma, pheochromocytoma, paraganglioma, neuroendocrine tumors of the gastroenteropancreatic tract, medullary thyroid carcinoma, multiple endocrine neoplasm syndromes
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