Le PET scan et le neuroblastome , de HOARAU

Le PET scan et le neuroblastome
Les mérastase osseuses d'un neuroblastome de la surénale gauche sont-elles facilement détectables avec ce type d'examen ?
Peut-on voir autre chose que les métastases ?

>CONCLUSION: Most neuroblastomas accumulate FDG.

Ceci étant tiré d'une publication de 1996.

>CONCLUSION: FDG PET is feasible, is useful in the study of tumors in children, and may provide unique, clinically important information.

Celle ci dans une revue de Radiology, en 1995.

>Metastatic neuroblastoma demonstrated by whole-body PET-CT using 11C-HED.

et ceci le titre d'une publication de 2005 dans une revue allemande.


Ceci dit, mon expérience sur les neuroblastomes est nulle, il s'agit d'une pathologie de Centres spécialisés, en général CHU, qui disposent de structures adaptées à la prise en charge des jeunes enfants.

Donc on serait tenté de répondre que potentiellement oui, à condition de disposer d'une machine de type pet-ct, en sachant que le fdg n'est peut être pas le traceur "ultime".

Je ne sais pas si des centres français ont collectées de grosses séries, ni même si le petscan est proposé dans le bilan initial. Si vous avez des informations complémentaires, merci de m'en faire part par email (voir "Nous contacter", vous remplacez _at_ par @).


Complément de réponse en ce qui concerne le neuroblastome, trouvé sur le site de la SNM.

"Neuroblastoma is the most common extracranial solid malignant tumor in children. It is a malignant tumor of primitive neural crest cells that may arise anywhere in the sympathetic ganglion chain or adrenal medulla. It has a tendency for tumor calcification, direct spread and metastases to bone and liver. About two-thirds of neuroblastomas arise in the abdomen and about two thirds of these lesions arise in the adrenal. They can originate in paravertebral sympathetic chain, presacral area, and celiac axis region or from the organ of Zuckerkandl. Disseminated disease is present in up to 70% of cases at the time of diagnosis. The diagnostic evaluation of the abdomen is by CT or MRI. CT is excellent for thoracic and abdominal imaging. Both CT and MRI offer multiplanar capabilities. MRI can assess adjacent organ, vascular and bone marrow involvement. MIBG scanning is an essential part of the work up. MIBG is analogous to norepinephrine and guanethidine. Medications including antihypertensives, tricyclic antidepressants, antipshychotics, and sympathomimetics interfere with MIBG uptake. Non-prescription medicines such as cough and cold medications containing pseudoephedrine most commonly interfere with interpretation. I –123 is preferred over I-131. The normal distribution of MIBG is in the salivary glands, myocardium, kidneys, urinary bladder, liver, spleen, adrenal and the bowel. Pre and post treatment with supersaturated potassium iodide decreases thyroidal uptake of unbound radioiodine. MIBG is given slowly intravenously over five minutes. Imaging is done 24 hours after I-123 MIBG. Planar images of the whole body in the anterior and posterior projections and SPECT images of the chest, abdomen and pelvis are usually done with I-123 MIBG. MIBG can detect extent of the disease better than bone scan while bone scanning is helpful in false negative MIBG scans. MIBG is superior to bone scan for detection of bony involvement. In-111 Pentreotide is less sensitive than I-123 MIBG for neuroblastoma. However In-111 Pentreotide can yield prognostic information suggesting a complementary role to MIBG. Multifocal metaphyseal involvement on bone scan is the characteristic pattern of involvement. Technetium diphosphonates have avidity for primary tumors. PET scanning is excellent in detecting smaller lesions. It helps localize and delineate the extent of neuroblastoma lesions due to its better spatial resolution. PET is useful in staging and restaging of neuroblastoma cases. PET scanning has a role in guiding treatment due to its ability to provide insights about tumor behavior. PET and bone marrow biopsy are used to monitor neuroblastoma patients at high risk for progressive disease in soft tissue, bone and bone marrow. A major drawback of PET is its inability to visualize lesions in the cranial vault due to high physiologic brain activity. PET is better than bone scan in evaluating osteo-medullary involvement. PET matches or surpasses the sensitivity of MIBG scans for detecting neuroblastoma in extracranial skeletal structures. PET and MIBG scans show similar patterns of diffusely abnormal skeletal findings in patients with extensive bone marrow involvement, but neither imaging modality can detect minimal BM disease."