Positive MIBG scanning at the time of relapse in neuroblastoma which was MIBG negative at diagnosis

Metaiodobenzylguanidine (MIBG) labelled with iodine-123 (¹²³I) or ¹³¹I has become a well established tool with high sensitivity and specificity in the diagnosis and staging of neuroblastoma in children. However, some neuroblastomas do not take up MIBG at the time of diagnosis. The reasons for this are unclear but may be related to uptake mechanisms. Follow-up MIBG scans have not been reported in these patients. We present a case where an initial ¹²³I-MIBG-scan was negative at diagnosis but became positive when the patient relapsed. This unusual occurrence may have implications for patients with a negative MIBG-scan at presentation. These patients should be re-evaluated by MIBG-scan at the time of relapse as a positive scan then offers the possibility of additional treatment with MIBG therapy.