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Drug interference with MIBG uptake in a patient with metastatic paraganglioma

¹ Department of Nuclear Medicine, Hospital of the J.W. Goethe-University, Frankfurt/Main and ² Department of Nuclear Medicine, Hospital of the Philipps-University, Marburg, Germany

Metaiodobenzylguanidine (MIBG) labelled with iodine-131 (¹³¹I) has become a well established therapeutic tool for inoperable metastastic tumours of paraganglioma. There are different pharmacological substances known to interfere with MIBG-uptake which may result in a false negative MIBG scan. We present the case of a 26-year-old male polytoxicomanic patient with metastatic paraganglioma, who underwent MIBG therapy. During earlier therapies, MIBG uptake in the metastatic lesions was very high. A post-therapeutic whole-body scan subsequent to recent ¹³¹I-MIBG therapy failed to detect the vast majority of metastatic lesions-except for two. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) showed metastases with a similar distribution to the initial MIBG scan. The possible reasons for the discrepancy in the findings of the MIBG scans and the ¹⁸F-FDG-PET scan are discussed with special emphasis on drug intake prior to MIBG administration, increased MIBG turn-over and unknown drug mixture interference with MIBG uptake.