Neuroblastoma Imaging Clinical Practice Guidelines (2018)

Clinical practice guidelines for imaging in neuroblastoma were released in October 2018 by the European Association of Nuclear Medicine.^[1]

mIBG Imaging

¹²³I-mIBG is the most common study in nuclear medicine for the evaluation of neuroblastoma. Certain medications can potentially affect mIBG uptake, and the European Association of Nuclear Medicine (EANM) recommends withholding labetalol, desipramine, reserpine, and phenylpropanolamine.

Thyroid Blockade for ¹²³I-mIBG – Potassium Iodate Tablets

Children ages 1 month to 3 years: administer 42.5 mg (half a tablet) potassium iodate orally 1 hour prior to mIBG injection, in the evening of that day, and on the following day after the mIBG scan (in total, three tablets in 2 days; in infants and young children the tablet can be crushed, dissolved in 2 mL of sterile water, and administered with a syringe to the back of the throat).

Children ages 3 to 12 years: administer 85 mg (one tablet) potassium iodate orally 1 hour prior to mIBG injection, in the evening of that day, and on the following day after the mIBG scan (in total, three tablets in 2 days).

Patients aged 12 years and older: administer 170 mg (two tablets) potassium iodate orally 1 hour prior to mIBG injection, in the evening of that day, and on the following day after the mIBG scan (in total, three tablets in 2 days).

Thyroid Blockade for ¹²³I-mIBG – Lugol’s Iodine Solution

Administer 0.6 mL of 5% solution orally per day 2 days before ¹²³I-mIBG injection, and continue for 3 days after injection.

Dilute the solution in milk or juice, as it may burn the throat if undiluted.

The dose can be given as a single dose each day or split into two doses of 0.3 mL each.

Thyroid Blockade for ¹³¹I-mIBG

Administer a saturated solution of potassium iodide (SSKI) 30–60 min prior to injection of ¹³¹I-mIBG, orally from day 0, and continue for a week.

Adult dosage: six drops of SSKI on day 0 and two drops of SSKI three times a day orally, beginning on the morning of day 1 and continuing for 1 week.

Children ages 1 month or younger: one drop orally 30–60 min prior to ¹³¹I-mIBG injection, then one drop orally in the morning of day 1, and daily for 1 week following injection.

Children ages 1 month to 3 years: two drops orally 30–60 min prior to ¹³¹I-mIBG injection, then one drop orally twice a day beginning in the morning of day 1 and continuing for 1 week following injection.

Children ages 3 to 18 years: three drops orally 30–60 min prior to ¹³¹I-mIBG injection, then one drop orally three times a day beginning in the morning of day 1 and continuing for 1 week following injection.

Adult patients and patients weighing ≥70 kg: six drops orally 30–60 min after ¹³¹I-mIBG injection, then two drops orally three times a day beginning in the morning of day 1 and continuing for 1 week following injection.

Thyroid Blockade with Potassium Perchlorate

Use potassium perchlorate in individuals sensitive to iodine, and if no other method for thyroid blockade is available.

Dose 10 mg/kg (maximum dose 500 mg, minimum dose 50 mg).

Potassium perchlorate comes in 200 mg capsules, and these should be opened and the contents either placed on a sugar lump (or similar) or dissolved in a flavored drink.

Potassium perchlorate is taken 1 hour prior to ¹²³I-mIBG injection and up to five times in the following 36 hours.

Medscape © 2018 WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Neuroblastoma Imaging Clinical Practice Guidelines (2018) - Medscape - Dec 05, 2018.