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Stable disease and improved health-related quality of life (HRQoL) following fractionated low dose ¹³¹I-metaiodobenzylguanidine (MIBG) therapy in metastatic paediatric paraganglioma: observation on false "reverse" discordance during pre-therapy work up and its implication for patient selection for high dose targeted therapy

Radiation Medicine Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Bombay 400 012, India

View larger version (50K): [in a new window]   Figure 1. 99Tcm-MDP bone scintigraphy showing abnormal focal uptake of tracer in the medial part of left supraorbital region, T4–T6 vertebrae, left shoulder, right 8th rib and right superolateral part of L3 vertebra.

View larger version (66K): [in a new window]   Figure 2. (a) 1 mCi diagnostic 131I-metaiodobenzylguanidine (MIBG) whole body scan 48 h post-injection demonstrated a well defined focal area of increased tracer uptake in midthoracic region (more evident in posterior view) and at an area inferomedial to the right lobe of liver. (b) Pre-therapy repeat 131I-MIBG posterior chest scan showing focal tracer uptake only at the region of T4–T6 vertebral lesions. Rest of the whole body survey did not reveal any abnormal tracer uptake.

View larger version (67K): [in a new window]   Figure 3. Post131I-MIBG treatment scan showing focal concentration in the medial part of left supraorbital region, T4–T6 vertebrae, left shoulder, right 8th rib and right superolateral part of L3 vertebra.